Provider Demographics
NPI:1508907320
Name:TULLOCK, ERIN (CNM)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TULLOCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-2190
Mailing Address - Country:US
Mailing Address - Phone:603-356-9355
Mailing Address - Fax:603-356-8843
Practice Address - Street 1:3073 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-7101
Practice Address - Country:US
Practice Address - Phone:603-356-9355
Practice Address - Fax:603-356-8843
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230304367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0364631Medicaid
NH30462788Medicaid
MARN027401Medicare PIN
RN0274Medicare ID - Type Unspecified