Healthcare Provider Details

I. General information

NPI: 1013312065
Provider Name (Legal Business Name): ERIN LYNN WELLER CROSBIE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 03/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 12TH ST
LONG BEACH CA
90813-2720
US

IV. Provider business mailing address

1301 W 12TH ST
LONG BEACH CA
90813-2720
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-4695
  • Fax: 562-264-4273
Mailing address:
  • Phone: 562-264-4695
  • Fax: 562-264-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: