MEDICARE: ERICKA WARD AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	4704320434	MI
2	363LA2100X	Acute Care Nurse Practitioner	4704320434	MI

General Provider Information

NPI Number	:	1164294062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA WARD AGACNP-BC

Provider Business Mailing Address
First Line	:	13750 VERNON ST
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1387
Country	:	US
Telephone Number	:	313-629-5120
Fax Number	:

Provider Business Practice Location Address
First Line	:	13750 VERNON ST
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1387
Country	:	US
Telephone Number	:	313-629-5120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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