MEDICARE: MRS. RENE SUE ERWIN

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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1952680852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENE SUE ERWIN

Provider Business Mailing Address
First Line	:	6232 FACTOR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107
Country	:	US
Telephone Number	:	702-509-0420
Fax Number	:	702-992-0391

Provider Business Practice Location Address
First Line	:	6232 FACTOR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2502
Country	:	US
Telephone Number	:	702-992-0576
Fax Number	:	702-992-0391

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

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	01/29/2015

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