1922236801 NPI number — ERIN COLLEEN LYTLE CRNP

Table of content: ERIN COLLEEN LYTLE CRNP (NPI 1922236801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922236801 NPI number — ERIN COLLEEN LYTLE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYTLE
Provider First Name:
ERIN
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH
Provider Other First Name:
ERIN
Provider Other Middle Name:
COLLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922236801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-360-4446
Provider Business Mailing Address Fax Number:
410-360-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21122-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-360-4446
Provider Business Practice Location Address Fax Number:
410-360-4449
Provider Enumeration Date:
06/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  R174779 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W6420007 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: W6420007 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 9807484 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 418074700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6225785 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 955929-01 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 95592901 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".




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