Provider Demographics
NPI:1023311057
Name:BOUMANSOUR, ERIN (ACNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOUMANSOUR
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2366 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8944
Mailing Address - Country:US
Mailing Address - Phone:877-227-8823
Mailing Address - Fax:
Practice Address - Street 1:2366 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8944
Practice Address - Country:US
Practice Address - Phone:877-227-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430568363LA2100X
MI4704311116363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care