Healthcare Provider Details

I. General information

NPI: 1477884609
Provider Name (Legal Business Name): ERICA OYE YIADOM RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DENISON ROAD
WORCESTER MA
01609-1222
US

IV. Provider business mailing address

2 DENNISON RD
WORCESTER MA
01609-1222
US

V. Phone/Fax

Practice location:
  • Phone: 774-253-8785
  • Fax:
Mailing address:
  • Phone: 774-253-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number275586
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number275586
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: