Provider Demographics
NPI:1811078074
Name:ERVIN, AISHA AMBER (RN)
Entity type:Individual
Prefix:MISS
First Name:AISHA
Middle Name:AMBER
Last Name:ERVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1627
Mailing Address - Country:US
Mailing Address - Phone:415-258-0388
Mailing Address - Fax:
Practice Address - Street 1:920 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3506
Practice Address - Country:US
Practice Address - Phone:415-499-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA664991163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA69495OtherPUBLIC HEALTH NURSE
CA664991OtherREGISTERED NURSE