Deford, Erica M

Deford, Erica M is an individual health care provider with primary practice located at 2805 N Knoxville Ave , Peoria IL 61604-2869. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Deford, Erica M can be contacted via phone (309) 624-9400.

Contact Information

Primary practice address
2805 N Knoxville Ave Peoria IL 61604-2869
Fax: (309) 624-2280
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085003126 Illinois

Profile Details

NPI number 1306020334
LBN Legal business name Deford, Erica M
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2007
Last updated Oct 2nd, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306020334 NPPES
Illinois Other 809840 MEDICARE GROUP PTAN
Illinois Other 776530 MEDICARE GROUP PTAN
Illinois Other 37-1221637 MEDICARE GROUP PTAN

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