Healthcare Provider Details

I. General information

NPI: 1275725731
Provider Name (Legal Business Name): ERIN WILKERSON GRISMER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 SAG HARBOR TURNPIKE
BRIDGEHAMPTON NY
11932
US

IV. Provider business mailing address

6 LEANDER RD
HAMPTON BAYS NY
11946-1214
US

V. Phone/Fax

Practice location:
  • Phone: 631-725-4683
  • Fax:
Mailing address:
  • Phone: 631-723-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number4618501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: