Provider Demographics
NPI:1740935352
Name:PEMBERTON, ERIN E (APS005409)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:APS005409
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-3148
Mailing Address - Country:US
Mailing Address - Phone:740-237-4981
Mailing Address - Fax:877-325-2816
Practice Address - Street 1:186 STANLEY ST
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-3148
Practice Address - Country:US
Practice Address - Phone:740-237-4981
Practice Address - Fax:877-325-2816
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHAPS.005409175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator