Healthcare Provider Details

I. General information

NPI: 1629596044
Provider Name (Legal Business Name): ERIN MARIE HASTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK RD STE 20
DAYTON OH
45414-5803
US

IV. Provider business mailing address

4160 LITTLE YORK RD STE 20
DAYTON OH
45414-5803
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9532
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005218RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005218RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: