Individual
ERICA JETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5620 W PHILIP PL, MILWAUKEE, WI 53216-3147
(414) 444-9477
Mailing address
5620 W PHILIP PL, MILWAUKEE, WI 53216-3147
(414) 444-9477
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303276-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35053200
—
WI
Enumeration date
04/23/2008
Last updated
04/23/2008
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