Healthcare Provider Details

I. General information

NPI: 1932505336
Provider Name (Legal Business Name): ERIN BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 NELSON DR
JACKSON MI
49203-5474
US

IV. Provider business mailing address

3777 NELSON DR
JACKSON MI
49203-5474
US

V. Phone/Fax

Practice location:
  • Phone: 517-740-8245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704274539
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.020506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: