Healthcare Provider Details

I. General information

NPI: 1265964431
Provider Name (Legal Business Name): ERIN LYNN GARDECK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN LYNN CAFLISCH PA

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 350
HOUSTON TX
77030-3004
US

IV. Provider business mailing address

6431 FANNIN STREET MSB 3.286
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 507-254-6311
  • Fax:
Mailing address:
  • Phone: 713-486-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12425
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: