Provider Demographics
NPI:1104320431
Name:ERSPAMER, MARIA AUDREY (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:AUDREY
Last Name:ERSPAMER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-0820
Mailing Address - Country:US
Mailing Address - Phone:520-678-6019
Mailing Address - Fax:559-235-7466
Practice Address - Street 1:5100 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2443
Practice Address - Country:US
Practice Address - Phone:520-678-6019
Practice Address - Fax:559-235-7466
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11118363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ369078Medicaid