Provider Demographics
NPI:1851969216
Name:FORDHAM, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SOMERSBY
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-6075
Mailing Address - Country:US
Mailing Address - Phone:801-362-7426
Mailing Address - Fax:
Practice Address - Street 1:1001 SOMERSBY
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-6075
Practice Address - Country:US
Practice Address - Phone:801-362-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program