Basic Information
Provider Information
NPI: 1477066835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NELSON
FirstName: ERIKA
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 W MCCREIGHT AVE STE 150
Address2:  
City: SPRINGFIELD
State: OH
PostalCode: 455041890
CountryCode: US
TelephoneNumber: 9373231404
FaxNumber: 9373231407
Practice Location
Address1: 100 W MCCREIGHT AVE STE 150
Address2:  
City: SPRINGFIELD
State: OH
PostalCode: 455041890
CountryCode: US
TelephoneNumber: 9373231404
FaxNumber: 9373231407
Other Information
ProviderEnumerationDate: 11/08/2017
LastUpdateDate: 04/10/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRNCNP021722OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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