Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01070636A | IN |
NPI | 1003127010 |
---|---|
Provider Name | Erica Huddleston |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46219-6803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201061620 | (05) | IN |
P01405403 | MEDICARE RR (01) | IN |