Healthcare Provider Details

I. General information

NPI: 1184155905
Provider Name (Legal Business Name): ERIANNA FLORES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ARROWOOD DR SUITE A
ITHACA NY
14850-1869
US

IV. Provider business mailing address

413 S ALBANY ST APT 2
ITHACA NY
14850-5407
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-7800
  • Fax: 607-216-0093
Mailing address:
  • Phone: 360-223-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001790
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: