Provider Demographics
NPI:1477903276
Name:FRUTH, ERIN (APN, AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FRUTH
Suffix:
Gender:F
Credentials:APN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:LOYOLA MEDICAL CENTER, DEPARTMENT OF UROLOGY
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-5100
Mailing Address - Fax:708-216-1699
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:LOYOLA MEDICAL CENTER, DEPARTMENT OF UROLOGY
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5100
Practice Address - Fax:708-216-1699
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013564364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health