MEDICARE: MRS. SUZANNE ERWIN-HOLMES

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1730417122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE ERWIN-HOLMES

Provider Business Mailing Address
First Line	:	1216 FOREST AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-2323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 FOREST AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-2323
Country	:	US
Telephone Number	:	515-339-3425
Fax Number	:	515-284-5886

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/24/2009

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