Provider Demographics
NPI:1568262574
Name:HUTSON, ERICA C (MED)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:C
Last Name:HUTSON
Suffix:
Gender:
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 PARK VISTA CT
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5500
Mailing Address - Country:US
Mailing Address - Phone:330-861-9561
Mailing Address - Fax:
Practice Address - Street 1:207 S PEARL ST # 2
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3417
Practice Address - Country:US
Practice Address - Phone:330-861-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTM176705172A00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver