Provider Demographics
NPI:1326207168
Name:ERVIN, JUDI LYNN (RN LMBT)
Entity type:Individual
Prefix:
First Name:JUDI
Middle Name:LYNN
Last Name:ERVIN
Suffix:
Gender:F
Credentials:RN LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 CHINABERRY CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104
Mailing Address - Country:US
Mailing Address - Phone:704-293-4379
Mailing Address - Fax:704-882-8586
Practice Address - Street 1:3007 CHINABERRY CT
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104
Practice Address - Country:US
Practice Address - Phone:704-293-4379
Practice Address - Fax:704-882-8586
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist