1861829327 NPI number — DR. ERICA NICOLE LURTEN AU.D.

Table of content: DR. ERICA NICOLE LURTEN AU.D. (NPI 1861829327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861829327 NPI number — DR. ERICA NICOLE LURTEN AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LURTEN
Provider First Name:
ERICA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861829327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 NW 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-4561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-715-6062
Provider Business Mailing Address Fax Number:
479-715-6064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 NW 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-715-6062
Provider Business Practice Location Address Fax Number:
479-715-6064
Provider Enumeration Date:
09/30/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  374 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)