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NPI Code Detail

MEDICARE: ERICKA ETHERINGTON NP

MEDICARE: ERICKA ETHERINGTON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner71007124AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1266180966OTHERINMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083143986
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICKA ETHERINGTON NP
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1340 N MADISON AVE
Second Line :
City : ANDERSON
State : IN
Zip : 46011-1216
Country : US
Telephone Number : 765-622-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2017
Last Update Date : 11/27/2023

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Directions to “ ERICKA ETHERINGTON NP” Practice Location

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