Basic Information
| Provider Information | |||||||||
| NPI: | 1588296453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAYNE | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | ELISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2603 39TH AVE NE STE D-202 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554214372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122132370 | ||||||||
| FaxNumber: | 6125245571 | ||||||||
| Practice Location | |||||||||
| Address1: | 2603 39TH AVE NE STE D-202 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554214372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122132370 | ||||||||
| FaxNumber: | 6125245571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110007098 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.