Healthcare Provider Details

I. General information

NPI: 1922578640
Provider Name (Legal Business Name): ERICA BOULWARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 H ST SE
WASHINGTON DC
20019-4981
US

IV. Provider business mailing address

770 ATLANTIC ST SE
WASHINGTON DC
20032-3739
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-0693
  • Fax:
Mailing address:
  • Phone: 202-638-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: