Provider Demographics
NPI:1760420244
Name:ERWIN, MANDY (DNP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35055 LA HIGHWAY 16 STE 2H
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1535
Mailing Address - Country:US
Mailing Address - Phone:225-791-2400
Mailing Address - Fax:225-791-2400
Practice Address - Street 1:35055 LA HIGHWAY 16 STE 2H
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-1535
Practice Address - Country:US
Practice Address - Phone:225-791-2400
Practice Address - Fax:225-791-4400
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04790363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1332178Medicaid
LA4H667Medicare ID - Type Unspecified
LA1332178Medicaid