Provider Demographics
NPI:1174105605
Name:WILSON, ERICKA DANAY
Entity type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:DANAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2708
Mailing Address - Country:US
Mailing Address - Phone:469-537-8346
Mailing Address - Fax:
Practice Address - Street 1:136 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2708
Practice Address - Country:US
Practice Address - Phone:469-537-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0061005064376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide