Healthcare Provider Details

I. General information

NPI: 1619133634
Provider Name (Legal Business Name): ERIN E MAIERLE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 BAYVIEW DR APT B
MANHATTAN BEACH CA
90266-5536
US

IV. Provider business mailing address

PO BOX 588
GREENDALE WI
53129-0588
US

V. Phone/Fax

Practice location:
  • Phone: 414-416-0400
  • Fax:
Mailing address:
  • Phone: 414-416-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: