Healthcare Provider Details

I. General information

NPI: 1588922058
Provider Name (Legal Business Name): ERIN ELIZABETH NASH-FAIRFAX EMT-P, R.N., PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ELIZABETH NASH EMT-P, R.N.

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29798 HAUN RD SUITE 207
MENIFEE CA
92586-6541
US

IV. Provider business mailing address

29798 HAUN RD SUITE 207
MENIFEE CA
92586-6541
US

V. Phone/Fax

Practice location:
  • Phone: 951-679-9700
  • Fax: 951-672-0835
Mailing address:
  • Phone: 951-679-9700
  • Fax: 951-672-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: