Provider Demographics
NPI:1922236801
Name:LYTLE, ERIN COLLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:COLLEEN
Last Name:LYTLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:COLLEEN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3100 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2018
Mailing Address - Country:US
Mailing Address - Phone:410-360-4446
Mailing Address - Fax:410-360-4449
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-360-4449
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174779363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
W6420007OtherBCBS DC
DCW6420007OtherBCBS
9807484OtherAETNA PPO
MD418074700Medicaid
6225785OtherAETNA HMO
MD955929-01OtherBCBS
95592901OtherBCBS MD