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NPI Code Detail

MEDICARE: ERIN DEHEER

MEDICARE: ERIN DEHEER
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
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1366960619
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN DEHEER
Provider Business Mailing Address
First Line : 21 DURHAM DR APT C
Second Line :
City : AMHERST
State : NY
Zip : 14228-2443
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4380 MAIN ST
Second Line :
City : AMHERST
State : NY
Zip : 14226-3544
Country : US
Telephone Number : 800-426-7652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 09/15/2017

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