Provider Demographics
NPI:1942013289
Name:COLVIN, JERICIA G (MBA)
Entity type:Individual
Prefix:
First Name:JERICIA
Middle Name:G
Last Name:COLVIN
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:JERICIA
Other - Middle Name:G
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA
Mailing Address - Street 1:4644 EICHELBERGER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2430
Mailing Address - Country:US
Mailing Address - Phone:937-993-8233
Mailing Address - Fax:
Practice Address - Street 1:3730 DELPHOS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1647
Practice Address - Country:US
Practice Address - Phone:937-263-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula