Basic Information
Provider Information
NPI: 1508011941
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RALLS
FirstName: ERIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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OtherCredential:  
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Mailing Information
Address1: PO BOX 7291
Address2:  
City: LEWISTON
State: ME
PostalCode: 042437291
CountryCode: US
TelephoneNumber: 2077774869
FaxNumber: 2077778800
Practice Location
Address1: 172 KINSLEY ST
Address2:  
City: NASHUA
State: NH
PostalCode: 03060
CountryCode: US
TelephoneNumber: 6038823000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/26/2008
LastUpdateDate: 07/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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