Provider Demographics
NPI:1457698417
Name:ERVIN, KELSI (ND)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 F ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3107
Mailing Address - Country:US
Mailing Address - Phone:360-734-1560
Mailing Address - Fax:360-734-3027
Practice Address - Street 1:1707 F ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3107
Practice Address - Country:US
Practice Address - Phone:360-734-1560
Practice Address - Fax:360-734-3027
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANATU.NT.60307425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine