Healthcare Provider Details

I. General information

NPI: 1588061865
Provider Name (Legal Business Name): DEBRA ELIZABETH ERICH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ROMAIN ROAD
MCCLELLANVILLE SC
29458
US

IV. Provider business mailing address

580 ROMAIN ROAD
MCCLELLANVILLE SC
29458
US

V. Phone/Fax

Practice location:
  • Phone: 843-364-0464
  • Fax:
Mailing address:
  • Phone: 843-364-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN-TP19188
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: