Healthcare Provider Details

I. General information

NPI: 1427470111
Provider Name (Legal Business Name): ERIN PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 SPRING HILL AVE
MOBILE AL
36604-1402
US

IV. Provider business mailing address

1725 SPRING HILL AVE
MOBILE AL
36604-1402
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-1367
  • Fax:
Mailing address:
  • Phone: 251-435-1367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-090548
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: