Provider Demographics
NPI:1366282352
Name:MCDONOUGH, ERIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 E PECOS RD STE 134
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8053
Mailing Address - Country:US
Mailing Address - Phone:480-840-9155
Mailing Address - Fax:480-840-9320
Practice Address - Street 1:2150 S DOBSON RD STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6487
Practice Address - Country:US
Practice Address - Phone:623-299-8799
Practice Address - Fax:623-299-8799
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily