Healthcare Provider Details

I. General information

NPI: 1275784589
Provider Name (Legal Business Name): ERIN ELIZABETH HENN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S PARK ST
KALAMAZOO MI
49001-5600
US

IV. Provider business mailing address

1212 S PARK ST
KALAMAZOO MI
49001-5600
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-0874
  • Fax: 269-344-7256
Mailing address:
  • Phone: 269-344-0874
  • Fax: 269-344-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5601005397
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5601005397
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: