Provider Demographics
NPI:1073659611
Name:ERDMANN, TATYANA (PA)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12075 E STATE ROUTE 69
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-4517
Mailing Address - Country:US
Mailing Address - Phone:928-772-1673
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:12075 E STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-4517
Practice Address - Country:US
Practice Address - Phone:928-772-1673
Practice Address - Fax:928-772-1674
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60313091363AM0700X
PAMA002868L363AM0700X
AZ6763363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical