Provider Demographics
NPI:1457860330
Name:ERVIN, THASSA ANTWINETTE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:THASSA
Middle Name:ANTWINETTE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-6901
Mailing Address - Country:US
Mailing Address - Phone:1989-714-2767
Mailing Address - Fax:
Practice Address - Street 1:2918 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:1989-714-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000036393376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide