Provider Demographics
NPI:1407511306
Name:BURNHAM, ERIN MOIRA (RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MOIRA
Last Name:BURNHAM
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 1:103 ANDREA PT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-6354
Mailing Address - Country:US
Mailing Address - Phone:864-245-1481
Mailing Address - Fax:
Practice Address - Street 1:103 ANDREA PT
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-6354
Practice Address - Country:US
Practice Address - Phone:864-245-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC228458163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty