MEDICARE: MARTHA ERICKSON

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	164X00000X	Licensed Vocational Nurse	312557	TX

General Provider Information

NPI Number	:	1841824901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA ERICKSON

Provider Business Mailing Address
First Line	:	7021 ICEBERG LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1113
Country	:	US
Telephone Number	:	210-379-3509
Fax Number	:

Provider Business Practice Location Address
First Line	:	7021 ICEBERG LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1113
Country	:	US
Telephone Number	:	210-379-3509
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/27/2020

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