Provider Demographics
NPI:1669160743
Name:ERVI, KJIRSTEN R (RN)
Entity type:Individual
Prefix:
First Name:KJIRSTEN
Middle Name:R
Last Name:ERVI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:825 S 169TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-9300
Mailing Address - Country:US
Mailing Address - Phone:402-354-4822
Mailing Address - Fax:
Practice Address - Street 1:1 EDMUNDSON PL STE 306
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4620
Practice Address - Country:US
Practice Address - Phone:712-396-7787
Practice Address - Fax:712-396-4115
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE80264163W00000X
NE115483363LF0000X
IAA176479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse