Healthcare Provider Details

I. General information

NPI: 1427153824
Provider Name (Legal Business Name): ERIS MARIE LONDON WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIS MARIE HEADD

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E BASELINE RD
PHOENIX AZ
85042-6530
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1600
PHOENIX AZ
85012-2908
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 602-276-4427
Mailing address:
  • Phone: 602-323-3344
  • Fax: 602-323-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2006027535
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number227493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: