Provider Demographics
NPI:1699810317
Name:EHRLICH, CAROLYN JEANNE (PSYCHIATRIC NURSE PR)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JEANNE
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:PSYCHIATRIC NURSE PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVENUE
Mailing Address - Street 2:SUITE #140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3449
Mailing Address - Country:US
Mailing Address - Phone:602-277-0663
Mailing Address - Fax:602-277-1849
Practice Address - Street 1:300 W CLARENDON AVENUE
Practice Address - Street 2:SUITE #140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3449
Practice Address - Country:US
Practice Address - Phone:602-277-0663
Practice Address - Fax:602-277-1849
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN021906363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S50511Medicare UPIN
AZ20974Medicare ID - Type Unspecified
AZ20774Medicare ID - Type Unspecified