Healthcare Provider Details

I. General information

NPI: 1629374962
Provider Name (Legal Business Name): ERIN C MOHAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 KNIGHT LANE BUILDING H NAVY MEDICINE SUPPORT COMMAND; MEDICAL STAFF SERVICES
JACKSONVILLE FL
32212-0140
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8038
  • Fax:
Mailing address:
  • Phone: 571-231-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number622338
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024188524
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: