Provider Demographics
NPI:1568545598
Name:DAVIS, ERIN LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:DAVIS
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 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:CONCOURSE LEVEL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:215-662-2428
Mailing Address - Fax:215-349-5923
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:CONCOURSE LEVEL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-662-2428
Practice Address - Fax:215-349-5923
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005988U363L00000X, 363LC0200X
NJNJ00190000363L00000X
NJ26NJ00190000363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP17377Medicare UPIN
PA079733Medicare PIN