Healthcare Provider Details

I. General information

NPI: 1205535556
Provider Name (Legal Business Name): CHARLES M ERWIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 COTTAGE PL NW
CANTON OH
44703-1169
US

IV. Provider business mailing address

1331 COTTAGE PL NW
CANTON OH
44703-1169
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-0694
  • Fax:
Mailing address:
  • Phone: 330-477-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.279827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: