Provider Demographics
NPI:1144454356
Name:WANN, ERIN ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ASHLEY
Last Name:WANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MED PLZ
Mailing Address - Street 2:SUITE 265
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-206-3165
Mailing Address - Fax:310-267-0261
Practice Address - Street 1:200 MED PLZ
Practice Address - Street 2:SUITE 265
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-3165
Practice Address - Fax:310-267-0261
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse