Provider Demographics
NPI:1972806081
Name:ERDLITZ, KATIE S (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:S
Last Name:ERDLITZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:S
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:19087B GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3899
Mailing Address - Country:US
Mailing Address - Phone:251-928-5568
Mailing Address - Fax:251-928-2605
Practice Address - Street 1:19087B GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3899
Practice Address - Country:US
Practice Address - Phone:251-928-5568
Practice Address - Fax:251-928-2605
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111750363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL122749Medicaid