Basic Information
| Provider Information | |||||||||
| NPI: | 1699318576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3772 N 85TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532222824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4145508346 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2814 S 108TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532273224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148853525 | ||||||||
| FaxNumber: | 2626431617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2019 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 321430 | WI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.