Healthcare Provider Details

I. General information

NPI: 1467096958
Provider Name (Legal Business Name): ERIN ELIZABETH CRAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 N ELSTON AVE STE 110
CHICAGO IL
60642-1501
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-3332
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-1100
  • Fax:
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085007229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: