Healthcare Provider Details

I. General information

NPI: 1710673660
Provider Name (Legal Business Name): ERICA L WALIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E SHAW AVE STE 109
FRESNO CA
93710-7903
US

IV. Provider business mailing address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-712-8800
  • Fax:
Mailing address:
  • Phone: 559-453-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95104506
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95025078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: