Healthcare Provider Details

I. General information

NPI: 1982007498
Provider Name (Legal Business Name): ERICKA GEDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 E 210TH ST
EUCLID OH
44123-1851
US

IV. Provider business mailing address

284 E 210TH ST
EUCLID OH
44123-1851
US

V. Phone/Fax

Practice location:
  • Phone: 216-256-5029
  • Fax:
Mailing address:
  • Phone: 216-256-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401168331110
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: