Provider Demographics
NPI:1578711586
Name:REDD, ERIN S (APN CNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:S
Last Name:REDD
Suffix:
Gender:F
Credentials:APN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 EASTLAND DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3532
Mailing Address - Country:US
Mailing Address - Phone:309-662-8813
Mailing Address - Fax:309-662-6835
Practice Address - Street 1:1404 EASTLAND DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3532
Practice Address - Country:US
Practice Address - Phone:309-662-8813
Practice Address - Fax:309-662-6835
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner