Provider Demographics
NPI:1669612701
Name:VIERUS, ERIN MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:VIERUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:WALLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 DOUGLAS FIR DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4735
Mailing Address - Country:US
Mailing Address - Phone:702-493-5926
Mailing Address - Fax:
Practice Address - Street 1:3705 FM 1488 RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-3951
Practice Address - Country:US
Practice Address - Phone:702-493-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001520363A00000X
NVPA1370363A00000X
TXPA09309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant