Basic Information
| Provider Information | |||||||||
| NPI: | 1417270968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERDMAN | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 READING RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137213200 | ||||||||
| FaxNumber: | 5136393186 | ||||||||
| Practice Location | |||||||||
| Address1: | 3747 W FORK RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134814777 | ||||||||
| FaxNumber: | 5133890473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1079789 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 3006377 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | 6377M | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 3006377 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | COA.14284-NM | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 7100111560 | 05 | KY | MEDICAID | 3041158 | 05 | OH | MEDICAID |