Basic Information
| Provider Information | |||||||||
| NPI: | 1073659611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERDMANN | ||||||||
| FirstName: | TATYANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12075 E STATE ROUTE 69 | ||||||||
| Address2: | |||||||||
| City: | DEWEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863274517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287721673 | ||||||||
| FaxNumber: | 9282136292 | ||||||||
| Practice Location | |||||||||
| Address1: | 12075 E STATE ROUTE 69 | ||||||||
| Address2: | |||||||||
| City: | DEWEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863274517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287721673 | ||||||||
| FaxNumber: | 9287721674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA60313091 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | MA002868L | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 6763 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.