Provider Demographics
NPI:1093025207
Name:PEZZULO, ERIN (RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PEZZULO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3606
Mailing Address - Country:US
Mailing Address - Phone:518-884-7200
Mailing Address - Fax:518-884-7234
Practice Address - Street 1:210 BALLSTON AVE
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3606
Practice Address - Country:US
Practice Address - Phone:518-884-7200
Practice Address - Fax:518-884-7234
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38944-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool