Provider Demographics
NPI:1336564996
Name:ERVIN, LAUREN MARIE (DNP, CNM)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARIE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41680 MISS BESSIE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2963
Mailing Address - Country:US
Mailing Address - Phone:619-977-4462
Mailing Address - Fax:
Practice Address - Street 1:41680 MISS BESSIE DR STE 102
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2963
Practice Address - Country:US
Practice Address - Phone:301-997-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171525367A00000X
MDR193033367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife