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General NPI Number Information
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NPI Number | 1386244358
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Entity Type | Individual
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Provider Name | NICHOLE ERHARDT
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 390 E CONGRESS PKWY STE I
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6207
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Country | US
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Telephone | 815-355-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 8615 COUNTRY SHIRE LN
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City | SPRING GROVE
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State | IL
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Zip | 60081-8990
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Country | US
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Telephone | 847-732-1328
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209022284
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License Number State | IL
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