Provider Demographics
NPI:1356694335
Name:MICKLINGHOFF, ERIN E (CNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:MICKLINGHOFF
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:22285 N PEPPER RD STE 311
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2541
Mailing Address - Country:US
Mailing Address - Phone:847-382-4410
Mailing Address - Fax:847-382-4451
Practice Address - Street 1:22285 N PEPPER RD STE 311
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2541
Practice Address - Country:US
Practice Address - Phone:847-382-4410
Practice Address - Fax:847-382-4451
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009783363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health