Healthcare Provider Details

I. General information

NPI: 1619353729
Provider Name (Legal Business Name): ERICA LYTHCOTT RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA NOELLE LYTHCOTT RN, BSN

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 N CLINTON AVE
TRENTON NJ
08609-1011
US

IV. Provider business mailing address

47 N CLINTON AVE
TRENTON NJ
08609-1011
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8787
  • Fax: 609-396-6280
Mailing address:
  • Phone: 609-396-8787
  • Fax: 609-396-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number26NR12251300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN625297
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: