Healthcare Provider Details

I. General information

NPI: 1124757083
Provider Name (Legal Business Name): ERIN MARIE MCWILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 LEAVITT AVE
JORDAN MT
59337
US

IV. Provider business mailing address

PO BOX 103
COHAGEN MT
59322-0103
US

V. Phone/Fax

Practice location:
  • Phone: 406-557-2500
  • Fax:
Mailing address:
  • Phone: 406-853-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-195092
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: