Healthcare Provider Details

I. General information

NPI: 1578227625
Provider Name (Legal Business Name): ERIN ANN NOLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 12/15/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W STOUT ST
RICE LAKE WI
54868-5001
US

IV. Provider business mailing address

1999 26TH ST
RICE LAKE WI
54868-9067
US

V. Phone/Fax

Practice location:
  • Phone: 715-236-8100
  • Fax:
Mailing address:
  • Phone: 715-790-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number179236
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11592
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: