Healthcare Provider Details

I. General information

NPI: 1063415024
Provider Name (Legal Business Name): ERIN M CARROLL NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 N MAIN ST STE 200
NORTH SYRACUSE NY
13212
US

IV. Provider business mailing address

792 N MAIN ST STE 200
NORTH SYRACUSE NY
13212-1644
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-8700
  • Fax: 315-701-1075
Mailing address:
  • Phone: 315-458-8700
  • Fax: 315-701-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF3601371
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343403-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: