Provider Demographics
NPI:1427153824
Name:LONDON, ERIS MARIE (WHNP)
Entity type:Individual
Prefix:
First Name:ERIS
Middle Name:MARIE
Last Name:LONDON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:ERIS
Other - Middle Name:MARIE
Other - Last Name:HEADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2908
Mailing Address - Country:US
Mailing Address - Phone:602-323-3344
Mailing Address - Fax:602-323-3399
Practice Address - Street 1:303 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6530
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-276-4427
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006027535363LW0102X
AZ227493363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health