Provider Demographics
NPI:1821348608
Name:ERVIN, MELANIE L (RN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:ERVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:L
Other - Last Name:ZEIGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:912 SAINT PAUL ST
Mailing Address - Street 2:APT 3R
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 S CHARLES ST
Practice Address - Street 2:CARRUTHERS CLINIC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3801
Practice Address - Country:US
Practice Address - Phone:410-328-2293
Practice Address - Fax:410-554-6603
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191085163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult