Provider Demographics
NPI:1356513485
Name:GOMPERT, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GOMPERT
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 1:212 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3742
Mailing Address - Country:US
Mailing Address - Phone:308-762-2545
Mailing Address - Fax:308-762-2564
Practice Address - Street 1:212 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3742
Practice Address - Country:US
Practice Address - Phone:308-762-2545
Practice Address - Fax:308-762-2564
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator