Healthcare Provider Details

I. General information

NPI: 1073014072
Provider Name (Legal Business Name): ERIN GOLDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 02/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N ORANGE ST
WILMINGTON DE
19801-1239
US

IV. Provider business mailing address

123A E AYRE ST
NEWPORT DE
19804-2506
US

V. Phone/Fax

Practice location:
  • Phone: 302-559-3603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: