Provider Demographics
NPI:1962167957
Name:BEACH, ERIN EILEEN (LPN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:EILEEN
Last Name:BEACH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11293 COUNTY ROUTE 77
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-2135
Mailing Address - Country:US
Mailing Address - Phone:315-955-5352
Mailing Address - Fax:
Practice Address - Street 1:11293 COUNTY ROUTE 77
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-2135
Practice Address - Country:US
Practice Address - Phone:315-955-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333245164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse