Provider Demographics
NPI:1831271345
Name:ERVIN, RICHARD C (ANP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:ERVIN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2815
Mailing Address - Country:US
Mailing Address - Phone:907-269-4234
Mailing Address - Fax:907-269-4235
Practice Address - Street 1:1300 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2815
Practice Address - Country:US
Practice Address - Phone:907-269-4234
Practice Address - Fax:907-269-4235
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK68779Medicare UPIN