MEDICARE: ERIN KREIDER NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0028304	OH

General Provider Information

NPI Number	:	1265009518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN KREIDER NP-C

Provider Business Mailing Address
First Line	:	2020 AMYS RIDGE EAST CT
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-7103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 AMYS RIDGE EAST CT
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-7103
Country	:	US
Telephone Number	:	937-427-0517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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