Provider Demographics
NPI:1053795096
Name:PEER, ERIN ELISE (NP-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELISE
Last Name:PEER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:KEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3702 NEW VISION DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 E DUPONT RD STE 3
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-672-6590
Practice Address - Fax:260-672-6599
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005562A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100465770Medicaid
IN71005562AOtherAPN LICENSE
IN71005562BOtherCSR LICENSE
IN01043132OtherSTATE LICENSE FOR JEFFERSON PEDIATRICS