Healthcare Provider Details

I. General information

NPI: 1124742671
Provider Name (Legal Business Name): ERIN GWINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 ROAD 52
PASCO WA
99301-8525
US

IV. Provider business mailing address

6010 ROAD 52
PASCO WA
99301-8525
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-7114
  • Fax:
Mailing address:
  • Phone: 509-416-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60221865
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: