Provider Demographics
NPI:1528024841
Name:YONTZ, ERIN A (CRNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:A
Last Name:YONTZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SOUTHERN BLVD STE 4100
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1266
Mailing Address - Country:US
Mailing Address - Phone:937-395-8444
Mailing Address - Fax:937-522-7513
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 4100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-395-8444
Practice Address - Fax:937-395-8450
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA07446NP363L00000X
OHNP07446363LX0001X
OHAPRN.CNP.07446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2674075Medicaid
OHCOA07446NPOtherOHIO LICENSE
YONP18511Medicare ID - Type Unspecified
OHCOA07446NPOtherOHIO LICENSE
NP18511Medicare PIN
OHQ46212Medicare UPIN