Healthcare Provider Details

I. General information

NPI: 1881730331
Provider Name (Legal Business Name): ERIN P. O'BRIEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN P. SIMPSON

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S MAIN ST
CANTON IL
61520-2670
US

IV. Provider business mailing address

175 S MAIN ST
CANTON IL
61520-2670
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-0201
  • Fax: 309-649-5302
Mailing address:
  • Phone: 309-647-0201
  • Fax: 309-649-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: