Healthcare Provider Details

I. General information

NPI: 1164914974
Provider Name (Legal Business Name): ERICA DARIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E WASHINGTON ST
SYRACUSE NY
13210-1173
US

IV. Provider business mailing address

6120 ROCK CUT RD LOT 53
JAMESVILLE NY
13078-9331
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-5960
  • Fax:
Mailing address:
  • Phone: 315-558-7529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number649960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: