Provider Demographics
NPI:1578770129
Name:ERDMAN, ANNESA RAE (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANNESA
Middle Name:RAE
Last Name:ERDMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 E FOX ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5230
Mailing Address - Country:US
Mailing Address - Phone:480-444-6170
Mailing Address - Fax:
Practice Address - Street 1:1676 E MCMURRAY BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-6014
Practice Address - Country:US
Practice Address - Phone:520-316-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily