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Individual

ANDROMEDA FAIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
3330 PEACH ST STE 106, ERIE, PA 16508-2771
(814) 877-8586
Mailing address
3330 PEACH ST STE 106, ERIE, PA 16508-2771
(814) 877-8586

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.382551
OH
163W00000X
Registered Nurse
RN642005
PA
363LF0000X
Family Nurse Practitioner
Primary
SP027602
PA
363LW0102X
Women's Health Nurse Practitioner
SP016598
PA

Other

Enumeration date
04/02/2016
Last updated
12/05/2025
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