MEDICARE: ERICA EGHAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025027647	NC

General Provider Information

NPI Number	:	1619839578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA EGHAN

Provider Business Mailing Address
First Line	:	3421 PEACH COBBLER ST
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-7159
Country	:	US
Telephone Number	:	773-987-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 PEACH COBBLER ST
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-7159
Country	:	US
Telephone Number	:	773-987-6821
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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