MEDICARE: MRS. VIRGINIA BAITY ERVIN MSN, APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	201626	NC

General Provider Information

NPI Number	:	1205839529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA BAITY ERVIN MSN, APRN, BC

Provider Business Mailing Address
First Line	:	108 W MOUNTAIN ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3413
Country	:	US
Telephone Number	:	704-739-5550
Fax Number	:	800-317-3563

Provider Business Practice Location Address
First Line	:	108 W MOUNTAIN ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3413
Country	:	US
Telephone Number	:	704-739-5550
Fax Number	:	800-317-3563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/03/2008

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