Provider Demographics
NPI:1902823933
Name:ERPENBACH, MIRIAM
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:ERPENBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:MAKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LVN
Mailing Address - Street 1:44 CACHE RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3755
Mailing Address - Country:US
Mailing Address - Phone:916-421-2196
Mailing Address - Fax:916-421-8169
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1527
Practice Address - Country:US
Practice Address - Phone:916-591-0385
Practice Address - Fax:916-874-9442
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN207412164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse