Healthcare Provider Details

I. General information

NPI: 1164415766
Provider Name (Legal Business Name): WOMENS CARE CENTER OF ERIE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 PEACH ST STE 302
ERIE PA
16509-1358
US

IV. Provider business mailing address

4402 PEACH ST STE 302
ERIE PA
16509-1358
US

V. Phone/Fax

Practice location:
  • Phone: 814-866-2010
  • Fax: 814-868-3420
Mailing address:
  • Phone: 814-866-2010
  • Fax: 814-868-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD042517E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP002262G
License Number StatePA

VIII. Authorized Official

Name: BRENDA E NEWPORT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-836-7505