Provider Demographics
NPI:1841812252
Name:ERVIN, YOLANDA YVONNE
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:YVONNE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 OAKLAND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3074
Mailing Address - Country:US
Mailing Address - Phone:803-233-2077
Mailing Address - Fax:
Practice Address - Street 1:1030 OAKLAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3074
Practice Address - Country:US
Practice Address - Phone:803-233-2077
Practice Address - Fax:803-233-5271
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies