Provider Demographics
NPI:1952680852
Name:ERWIN, RENE SUE
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:SUE
Last Name:ERWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RENE
Other - Middle Name:SUE
Other - Last Name:ERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6232 FACTOR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107
Mailing Address - Country:US
Mailing Address - Phone:702-509-0420
Mailing Address - Fax:702-992-0391
Practice Address - Street 1:6232 FACTOR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2502
Practice Address - Country:US
Practice Address - Phone:702-992-0576
Practice Address - Fax:702-992-0391
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency