Provider Demographics
NPI:1023571593
Name:ERIE MEDICAL REVIEW LLC
Entity type:Organization
Organization Name:ERIE MEDICAL REVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FIAL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, ACNPC-AG, RN-BC
Authorized Official - Phone:419-271-8467
Mailing Address - Street 1:900 W BOGART RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7301
Mailing Address - Country:US
Mailing Address - Phone:419-271-8467
Mailing Address - Fax:310-361-0429
Practice Address - Street 1:900 W BOGART RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7301
Practice Address - Country:US
Practice Address - Phone:419-271-8467
Practice Address - Fax:310-361-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty