Provider Demographics
NPI:1700306743
Name:WAHOME, ERICK N (RN)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:N
Last Name:WAHOME
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 SPRING WHEAT ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-5670
Mailing Address - Country:US
Mailing Address - Phone:816-739-3429
Mailing Address - Fax:
Practice Address - Street 1:3420 SPRING WHEAT ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-5670
Practice Address - Country:US
Practice Address - Phone:816-739-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95090786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse