Provider Demographics
NPI:1083086375
Name:SIROVINA, ERIN LYNN (APNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:SIROVINA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LYNN
Other - Last Name:SCHULPIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC SPECIAL NEEDS
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6943
Mailing Address - Fax:414-266-2926
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC SPECIAL NEEDS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6943
Practice Address - Fax:414-266-2926
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6700-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083086375Medicaid
WIK400262178Medicare PIN