Provider Demographics
NPI:1528077872
Name:DUVALL, ERIN RAE (LAC, ARNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:RAE
Last Name:DUVALL
Suffix:
Gender:F
Credentials:LAC, ARNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RAE
Other - Last Name:ERDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:23 S WENATCHEE AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2285
Mailing Address - Country:US
Mailing Address - Phone:206-351-5610
Mailing Address - Fax:509-266-0310
Practice Address - Street 1:23 S WENATCHEE AVE STE 125
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2285
Practice Address - Country:US
Practice Address - Phone:509-699-5264
Practice Address - Fax:509-266-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60603152363LF0000X, 363LF0000X
WAAC00001959171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8966980OtherMEDICARE PTAN WVH
WA1528077872Medicaid
WAG8966981OtherMEDICARE PTAN WVH
WAG8945738Medicare PIN