MEDICARE: ERIN M CARROLL NP, CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	F3601371	NY
2	363LF0000X	Family Nurse Practitioner	F343403-1	NY

General Provider Information

NPI Number	:	1063415024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN M CARROLL NP, CNM

Provider Business Mailing Address
First Line	:	792 N MAIN ST STE 200
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-1644
Country	:	US
Telephone Number	:	315-458-8700
Fax Number	:	315-701-1075

Provider Business Practice Location Address
First Line	:	792 N MAIN ST STE 200
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212
Country	:	US
Telephone Number	:	315-458-8700
Fax Number	:	315-701-1075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/17/2019

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