Provider Demographics
NPI:1013931666
Name:FENZEL, ERIN MARIE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:FENZEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:MILCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1492 E BROAD ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1546
Mailing Address - Country:US
Mailing Address - Phone:614-252-7561
Mailing Address - Fax:614-252-7564
Practice Address - Street 1:1492 E BROAD ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1546
Practice Address - Country:US
Practice Address - Phone:614-252-7561
Practice Address - Fax:614-252-7564
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant