Healthcare Provider Details

I. General information

NPI: 1467982470
Provider Name (Legal Business Name): ERIN MARIE FIORE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MARIE WILSON

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

31314 E RUTLAND ST
BEVERLY HILLS MI
48025-5424
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-8735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704268693
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704268693
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: