Provider Demographics
NPI:1104404029
Name:PRESCOTT, ERIN SIOBHAN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:SIOBHAN
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FOOTE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3406
Mailing Address - Country:US
Mailing Address - Phone:860-368-9320
Mailing Address - Fax:
Practice Address - Street 1:401 FOOTE RD
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-3406
Practice Address - Country:US
Practice Address - Phone:860-368-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000000000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health