Provider Demographics
NPI:1336961390
Name:ERVIN, LASHAWN
Entity type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:ERVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 GATEHOUSE DR APT F
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4195
Mailing Address - Country:US
Mailing Address - Phone:614-427-8997
Mailing Address - Fax:
Practice Address - Street 1:5302 GATEHOUSE DR APT F
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-4195
Practice Address - Country:US
Practice Address - Phone:614-427-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH114815164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse