Individual ProviderErin Amanda EzzellRegistered NurseNursing Service ProvidersPractice Address4212 N 16th St, Phoenix, AZ 85016-5319(602) 263-1200PECOS EnrollmentBased on the most recent information from CMS, provider Erin Amanda Ezzell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1184944142Provider TypeIndividualFull NameEzzell, Erin AmandaCredentialR.N.GenderFemaleSole ProprietorNoEnumeration Date6/1/2010Last Updated6/1/2010Contact InformationPractice LocationPractice Address4212 N 16th St, Phoenix, AZ 85016-5319Phone(602) 263-1200Fax(602) 263-1631Mailing LocationMailing AddressPO Box 31001-0698, Pasadena, CA 91110-0698Phone(602) 263-1200Fax(602) 263-1631Provider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense0001175094VirginiaProvider IdentifiersIDDescriptionIssuerID# 12DescriptionMedicaidIssuerUnlistedArizona