Provider Demographics
NPI:1427821321
Name:IRVIN, JAVON
Entity type:Individual
Prefix:
First Name:JAVON
Middle Name:
Last Name:IRVIN
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 1:521 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2903
Mailing Address - Country:US
Mailing Address - Phone:513-514-4814
Mailing Address - Fax:
Practice Address - Street 1:521 HICKORY ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2903
Practice Address - Country:US
Practice Address - Phone:513-514-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OH99999999171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant