Healthcare Provider Details

I. General information

NPI: 1497216550
Provider Name (Legal Business Name): ERIKA SOULES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 12/26/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 E LOHMAN AVE
LAS CRUCES NM
88011-8267
US

IV. Provider business mailing address

1401 JUNIPER AVE
LAS CRUCES NM
88001-8800
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-6400
  • Fax:
Mailing address:
  • Phone: 575-571-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: