Provider Demographics
NPI:1912239476
Name:ROBERTS, ERIN M (FNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N DELAWARE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-3770
Mailing Address - Fax:810-648-3352
Practice Address - Street 1:114 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2112
Practice Address - Country:US
Practice Address - Phone:860-664-0787
Practice Address - Fax:860-664-1982
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243791363LF0000X
CT6106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG66002038Medicare PIN