Healthcare Provider Details

I. General information

NPI: 1912239476
Provider Name (Legal Business Name): ERIN M ROBERTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MAIN ST
CLINTON CT
06413-2112
US

IV. Provider business mailing address

120 N DELAWARE ST SUITE 1
SANDUSKY MI
48471-1009
US

V. Phone/Fax

Practice location:
  • Phone: 860-664-0787
  • Fax: 860-664-1982
Mailing address:
  • Phone: 810-648-3770
  • Fax: 810-648-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704243791
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6106
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: