Provider Demographics
NPI:1912721481
Name:WOFFORD, ERICA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WOFFORD
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5328 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4769
Mailing Address - Country:US
Mailing Address - Phone:708-769-3992
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3852
Practice Address - Country:US
Practice Address - Phone:312-942-8120
Practice Address - Fax:312-942-5229
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030288363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health