Provider Demographics
NPI:1194848440
Name:MANDEVILLE, ERINN (CNM)
Entity Type:Individual
Prefix:
First Name:ERINN
Middle Name:
Last Name:MANDEVILLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8715
Mailing Address - Country:US
Mailing Address - Phone:802-888-8100
Mailing Address - Fax:
Practice Address - Street 1:530 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8715
Practice Address - Country:US
Practice Address - Phone:802-888-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
MARN2299308367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife