Provider Demographics
NPI:1801416797
Name:ERVIN, JAMEL A (MA,HCA)
Entity Type:Individual
Prefix:
First Name:JAMEL
Middle Name:A
Last Name:ERVIN
Suffix:
Gender:M
Credentials:MA,HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29109 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2860
Mailing Address - Country:US
Mailing Address - Phone:206-504-9595
Mailing Address - Fax:
Practice Address - Street 1:29109 47TH AVE S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2860
Practice Address - Country:US
Practice Address - Phone:206-504-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide