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General NPI Number Information
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NPI Number | 1902372139
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Entity Type | Individual
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Provider Name | ERIN FANNON
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Gender | Female
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 1450 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4405
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Country | US
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Telephone | 203-789-3351
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Fax |
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Provider Business Mailing Address
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Address Line | 996 MAIN ST APT 216
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City | BRANFORD
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State | CT
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Zip | 06405-7708
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 129872
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 7971
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN2342913
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 080854-23
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License Number State | NH
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