Healthcare Provider Details

I. General information

NPI: 1811405020
Provider Name (Legal Business Name): ERICA BECK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA ROTHAN

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

10413 BUGLE WAY
HARRISON OH
45030-7524
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax:
Mailing address:
  • Phone: 513-288-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.19119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: