Provider Demographics
NPI:1902534100
Name:EIDSON, ERICA DANIELLE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DANIELLE
Last Name:EIDSON
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 1:114 BELLAMY AVE
Mailing Address - Street 2:
Mailing Address - City:SURGOINSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37873-2700
Mailing Address - Country:US
Mailing Address - Phone:423-345-0333
Mailing Address - Fax:423-345-0336
Practice Address - Street 1:114 BELLAMY AVE
Practice Address - Street 2:
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873-2700
Practice Address - Country:US
Practice Address - Phone:423-345-0333
Practice Address - Fax:423-345-0336
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach