Provider Demographics
NPI:1407377435
Name:MCDERMOTT, ERIN O'NEILL (MSN, CRNP, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:O'NEILL
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MSN, CRNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1907
Mailing Address - Country:US
Mailing Address - Phone:856-905-8732
Mailing Address - Fax:
Practice Address - Street 1:1906 TUSTIN ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:856-905-8732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016511363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP016511OtherPA STATE CRNP LICENSE