Provider Demographics
NPI:1225543283
Name:WUST, ERIN (RN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WUST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 EMERY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3656
Mailing Address - Country:US
Mailing Address - Phone:478-464-0612
Mailing Address - Fax:
Practice Address - Street 1:180 EMERY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3656
Practice Address - Country:US
Practice Address - Phone:478-464-0612
Practice Address - Fax:478-464-0004
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218968163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management