Basic Information
| Provider Information | |||||||||
| NPI: | 1538263694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMAHON | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KIRSTEN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 SOUTH HOOP POLE RD | ||||||||
| Address2: | |||||||||
| City: | GUILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032149684 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 WEST CAMPUS DRIVE | ||||||||
| Address2: | YALE SCHOOL OF NURSING | ||||||||
| City: | ORANGE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882309 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 09/06/2013 | ||||||||
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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 | 367A00000X | 000177 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000177 | 01 | CT CARE | OTHER | 004235736 | 05 | CT | MEDICAID | 40CNM0177CT01 | 01 | ANTHEM BCBS | OTHER |