Healthcare Provider Details

I. General information

NPI: 1184746794
Provider Name (Legal Business Name): LOUISE RUTH ERWIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

11 LIBRA DR
NOVATO CA
94947-1915
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-6830
  • Fax:
Mailing address:
  • Phone: 415-897-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number264415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: