Provider Demographics
NPI:1225807654
Name:ERVIN, SARAH (MSCN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 SW FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4430
Mailing Address - Country:US
Mailing Address - Phone:971-404-8500
Mailing Address - Fax:
Practice Address - Street 1:6335 SW FISHER AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4430
Practice Address - Country:US
Practice Address - Phone:971-404-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist