Healthcare Provider Details

I. General information

NPI: 1982600276
Provider Name (Legal Business Name): CINDY D. ERWIN P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LANE AVERA MEDICAL GROUP PIERRE
PIERRE SD
57501
US

IV. Provider business mailing address

100 MAC LANE AVERA MEDICAL GROUP PIERRE
PIERRE SD
57501
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-5267
  • Fax: 605-945-5295
Mailing address:
  • Phone: 605-945-5267
  • Fax: 605-945-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0371
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: