Healthcare Provider Details

I. General information

NPI: 1124818901
Provider Name (Legal Business Name): ERIN ELIZABETH CAUGHEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BANJO LN
CENTREVILLE MD
21617-1002
US

IV. Provider business mailing address

120 BANJO LN
CENTREVILLE MD
21617-1002
US

V. Phone/Fax

Practice location:
  • Phone: 814-327-2293
  • Fax:
Mailing address:
  • Phone: 814-327-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number206633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: