Provider Demographics
NPI:1740237015
Name:ERVIN, CHERYL RENAE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:RENAE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N MARKET ST
Mailing Address - Street 2:PO BOX 535
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2231
Mailing Address - Country:US
Mailing Address - Phone:989-942-4084
Mailing Address - Fax:
Practice Address - Street 1:316 N MARKET ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2231
Practice Address - Country:US
Practice Address - Phone:989-942-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-087130367500000X
WAAP30005341367500000X
OR099007663CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered