Healthcare Provider Details

I. General information

NPI: 1730013848
Provider Name (Legal Business Name): ERICA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEBBLE HILL DR
BELLEVILLE IL
62223-2249
US

IV. Provider business mailing address

21 PEBBLE HILL DR
BELLEVILLE IL
62223-2249
US

V. Phone/Fax

Practice location:
  • Phone: 618-772-0794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2025050639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: