Provider Demographics
NPI:1508429457
Name:COLVARD, ERIN (RD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:COLVARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 12TH ST APT 1049
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-7711
Mailing Address - Country:US
Mailing Address - Phone:602-999-4980
Mailing Address - Fax:
Practice Address - Street 1:16601 N 12TH ST APT 1049
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-7711
Practice Address - Country:US
Practice Address - Phone:602-999-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant