Provider Demographics
NPI:1770957904
Name:FORTENER, ERIN LYNN (NPC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:FORTENER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10664 NESTLING DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-0867
Mailing Address - Country:US
Mailing Address - Phone:937-901-1387
Mailing Address - Fax:
Practice Address - Street 1:10664 NESTLING DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0867
Practice Address - Country:US
Practice Address - Phone:937-901-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.327703363LF0000X
OHAPRN.CNP.18629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155003Medicaid