Provider Demographics
NPI:1063756138
Name:HUSCH, ERIN A
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:A
Last Name:HUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:SOMMERVOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:492 S BIERMA ST
Mailing Address - Street 2:P.O. BOX 247
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-6004
Mailing Address - Country:US
Mailing Address - Phone:219-956-2110
Mailing Address - Fax:
Practice Address - Street 1:492 S BIERMA ST
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:IN
Practice Address - Zip Code:46392-6004
Practice Address - Country:US
Practice Address - Phone:219-956-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28162017A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner