Healthcare Provider Details

I. General information

NPI: 1871049106
Provider Name (Legal Business Name): DEVON ERVIN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S CEDAR CREST BLVD 414
ALLENTOWN PA
18103-6369
US

IV. Provider business mailing address

1240 S. CEDAR CREAST BLVD 414
ALLENTOWN PA
18103
US

V. Phone/Fax

Practice location:
  • Phone: 610-404-1390
  • Fax: 610-402-2754
Mailing address:
  • Phone: 610-404-1390
  • Fax: 610-402-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberPGC000035
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: