Healthcare Provider Details

I. General information

NPI: 1023571593
Provider Name (Legal Business Name): ERIE MEDICAL REVIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W BOGART RD
SANDUSKY OH
44870-7301
US

IV. Provider business mailing address

900 W BOGART RD
SANDUSKY OH
44870-7301
US

V. Phone/Fax

Practice location:
  • Phone: 419-271-8467
  • Fax: 310-361-0429
Mailing address:
  • Phone: 419-271-8467
  • Fax: 310-361-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL ROBERT FIAL
Title or Position: NURSE PRACTITIONER
Credential: CNP, ACNPC-AG, RN-BC
Phone: 419-271-8467