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NPI Code Detail

MEDICARE: MRS. KATHRYN ERHAHON-ILEN-OTUMA FNP

MEDICARE: MRS. KATHRYN ERHAHON-ILEN-OTUMA FNP
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
1363LF0000XFamily Nurse Practitioner95023595CA

General Provider Information

NPI Number : 1770209025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN ERHAHON-ILEN-OTUMA FNP
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 18546 ROSCOE BLVD STE 300
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91324-5458
Country : US
Telephone Number : 818-886-4028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2022
Last Update Date : 03/03/2026

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