Provider Demographics
NPI:1962777573
Name:DAISLEY, ERIN (RN, FNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DAISLEY
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 CENTER AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4670
Mailing Address - Country:US
Mailing Address - Phone:925-324-2555
Mailing Address - Fax:
Practice Address - Street 1:597 CENTER AVE STE 280
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4670
Practice Address - Country:US
Practice Address - Phone:925-324-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA795439163W00000X, 163WC0400X
CA95002578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily