Healthcare Provider Details

I. General information

NPI: 1245869585
Provider Name (Legal Business Name): ERICA NAGRA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W DELAWARE ST
DECATUR MI
49045-1106
US

IV. Provider business mailing address

5411 SAQUARO TRL
KALAMAZOO MI
49009-6414
US

V. Phone/Fax

Practice location:
  • Phone: 269-423-7686
  • Fax: 269-423-8282
Mailing address:
  • Phone: 269-271-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704238589
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: