Provider Demographics
NPI:1316495666
Name:ERVIN, VICTORIA (NP-C)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400- CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:800-527-6266
Mailing Address - Fax:313-576-8381
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:MAILCODE WB01AO
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:313-576-8355
Practice Address - Fax:313-576-8381
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704323788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily