Provider Demographics
NPI:1043560386
Name:GWIN, ERICA R (RN)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:R
Last Name:GWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:R
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3148 LARUE DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3916
Mailing Address - Country:US
Mailing Address - Phone:937-789-0579
Mailing Address - Fax:
Practice Address - Street 1:3148 LARUE DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3916
Practice Address - Country:US
Practice Address - Phone:937-789-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.324279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse