Provider Demographics
NPI:1255565685
Name:VAN TIEM, ERIN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:VAN TIEM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:990 W ANN ARBOR TRL STE 205
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1686
Practice Address - Country:US
Practice Address - Phone:734-455-6881
Practice Address - Fax:734-455-6891
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005456OtherSTATE LICENSE