Provider Demographics
NPI:1386001287
Name:ERWIN, PATTY (ADVANCED)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:ADVANCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 STABLE DR
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-2317
Mailing Address - Country:US
Mailing Address - Phone:618-922-5244
Mailing Address - Fax:
Practice Address - Street 1:102 STABLE DR
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-2317
Practice Address - Country:US
Practice Address - Phone:618-922-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2009-00103171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter