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General NPI Number Information
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NPI Number | 1124314513
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Entity Type | Individual
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Provider Name | ERIN R VAN WAGENEN MD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 12 HIGH ST STE 302
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City | LEWISTON
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State | ME
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Zip | 04240-7690
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Country | US
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Telephone | 207-795-5730
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Fax | 207-795-5749
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Provider Business Mailing Address
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Address Line | 12 HIGH ST STE 302
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City | LEWISTON
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State | ME
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Zip | 04240-7690
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Country | US
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Telephone | 207-795-5730
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Fax | 207-795-5749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD20134
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License Number State | ME
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