Provider Demographics
NPI:1962547661
Name:EVANS, ERMA M (CNM)
Entity type:Individual
Prefix:
First Name:ERMA
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FIRST PARK DR
Mailing Address - Street 2:STE D
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5369
Mailing Address - Country:US
Mailing Address - Phone:207-877-7477
Mailing Address - Fax:207-877-7171
Practice Address - Street 1:25 FIRST PARK DR
Practice Address - Street 2:STE D
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5369
Practice Address - Country:US
Practice Address - Phone:207-877-7477
Practice Address - Fax:207-877-7171
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER044571176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME625230099Medicaid