Healthcare Provider Details

I. General information

NPI: 1417208802
Provider Name (Legal Business Name): ERIN E DANA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN SHALLCROSS

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 PRAIRIE AVE
PROVIDENCE RI
02905-1928
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-9000
  • Fax: 401-444-0427
Mailing address:
  • Phone: 401-780-2511
  • Fax: 401-780-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNPP37713
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37713
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01187
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: