Provider Demographics
NPI:1316180524
Name:SIPE, ERIN BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BROOKE
Last Name:SIPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 MARIETTA HWY
Mailing Address - Street 2:#142
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8212
Mailing Address - Country:US
Mailing Address - Phone:770-704-0057
Mailing Address - Fax:770-704-0223
Practice Address - Street 1:2920 MARIETTA HWY
Practice Address - Street 2:#142
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8212
Practice Address - Country:US
Practice Address - Phone:770-704-0057
Practice Address - Fax:770-704-0223
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF0309071OtherAANP
GARN167888OtherGEORGIA RN LICENSE