MEDICARE: RUSSELL DEAN ERWIN NP

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	363LF0000X	Family Nurse Practitioner	AP04296	LA
2	207R00000X	Internal Medicine Physician	AP04296	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1700805801	OTHER	LA	NPI

General Provider Information

NPI Number	:	1700805801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL DEAN ERWIN NP

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-791-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	31985 LA HIGHWAY 16 STE A
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-1462
Country	:	US
Telephone Number	:	225-791-8800
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/12/2026

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