Healthcare Provider Details

I. General information

NPI: 1780286534
Provider Name (Legal Business Name): ERIN RENEE WALLIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN GOLDSCHMIDT

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

PO BOX 22407
SAINT LOUIS MO
63126-0407
US

V. Phone/Fax

Practice location:
  • Phone: 636-386-7222
  • Fax:
Mailing address:
  • Phone: 636-386-7222
  • Fax: 636-386-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2021026214
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC-APN.0106214-C-CR
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: