Provider Demographics
NPI:1699199547
Name:MEEHAN-AMO, ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MEEHAN-AMO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EIRN
Other - Middle Name:
Other - Last Name:MEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:650 W EASTERDAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1626
Mailing Address - Country:US
Mailing Address - Phone:906-635-2110
Mailing Address - Fax:906-635-0337
Practice Address - Street 1:650 W EASTERDAY AVE
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-635-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF06016110Medicare PIN