Healthcare Provider Details

I. General information

NPI: 1245778232
Provider Name (Legal Business Name): ERIN LISTERMANN RN, CNM, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9815
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9815
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6999
  • Fax: 304-201-5019
Mailing address:
  • Phone: 304-757-6999
  • Fax: 304-201-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78395
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN78395MIDWIFE
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: