Healthcare Provider Details

I. General information

NPI: 1285033480
Provider Name (Legal Business Name): ERIN MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN BERGER RN

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CENTRAL ST
GARDINER ME
04345-2404
US

IV. Provider business mailing address

49 CENTRAL ST
GARDINER ME
04345-2404
US

V. Phone/Fax

Practice location:
  • Phone: 207-458-7126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN5403
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: