Provider Demographics
NPI:1386811131
Name:WEST, ERICA JANE (RN, LAC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:WEST
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:JANE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LAC
Mailing Address - Street 1:831 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6404
Mailing Address - Country:US
Mailing Address - Phone:215-500-9384
Mailing Address - Fax:
Practice Address - Street 1:1080 N DELAWARE AVE
Practice Address - Street 2:SUITE 300 D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4330
Practice Address - Country:US
Practice Address - Phone:267-570-3693
Practice Address - Fax:267-773-4430
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000640171100000X
PARN653803163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist