Deangela Michelle Ervin
Individual provider Active NPI Contractor · Charlotte, NC
NPI 1275746497 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1275746497
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- MHL-060-1010 (NC)
- Practice address
- 1069 Brianna Way
Charlotte, NC 28217-1261 - Phone
- (704) 525-4069
- Fax
- (704) 525-4069
- NPI assigned
- May 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MHL-060-1010 | NC | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ervin House | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | MHL-060-1010 | NC | Yes |
Addresses
Primary practice location
1069 Brianna Way
Charlotte, NC 28217-1261
Mailing address
1069 Brianna Way
Charlotte, NC 28217-1261
Phone (704) 525-4069
Other providers in Charlotte, NC
- Glenn W Errington
- Erron S Brady DMD PA
- Erron S Brady DMD PA
- Ervin House
- Ervin S. Batchelor, PA
- Margaret Ervin
- Shannon Ruth Ervin
- Stefanie Suzane Ervin
- Jessica Erwin
- Mack Erwin
All providers in Charlotte, NC · Contractor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.