Provider Demographics
NPI:1104294438
Name:BARTLEY, ERICA (BSN, RN, CWOCN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:BSN, RN, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 TAYLOR ST
Mailing Address - Street 2:SUITE 4-E
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2923
Mailing Address - Country:US
Mailing Address - Phone:803-296-8906
Mailing Address - Fax:
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:SUITE 4-E
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-296-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC216971163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care