=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831438985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MARIE HERHOLD PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2013
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 MYRTLE ST STE: 160
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16502-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-456-9197
-----------------------------------------------------
Fax | 814-455-2765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1910 SASSAFRAS ST STE 100
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16502-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-456-9197
-----------------------------------------------------
Fax | 814-455-2765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | MA056660
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------