Healthcare Provider Details

I. General information

NPI: 1699603407
Provider Name (Legal Business Name): MS. ERIN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SEWARD ST
PARK FOREST IL
60466-1039
US

IV. Provider business mailing address

402 SEWARD ST
PARK FOREST IL
60466-1039
US

V. Phone/Fax

Practice location:
  • Phone: 708-879-6546
  • Fax: 708-879-6546
Mailing address:
  • Phone: 708-879-6546
  • Fax: 708-879-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: