Healthcare Provider Details

I. General information

NPI: 1497028237
Provider Name (Legal Business Name): ERICA L. DELMORE DEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S 8TH ST
LAS VEGAS NV
89101-7005
US

IV. Provider business mailing address

1416 MARYLAND HEIGHTS AVE
LAS VEGAS NV
89183-7931
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-3248
  • Fax: 702-825-0795
Mailing address:
  • Phone: 702-324-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number8786
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: