=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588922058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ELIZABETH NASH-FAIRFAX EMT-P, R.N., PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2012
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29798 HAUN RD SUITE 207
-----------------------------------------------------
City | MENIFEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92586-6541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-679-9700
-----------------------------------------------------
Fax | 951-672-0835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29798 HAUN RD SUITE 207
-----------------------------------------------------
City | MENIFEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92586-6541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-679-9700
-----------------------------------------------------
Fax | 951-672-0835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA22180
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------