Individual
MISS DEANGELA MICHELLE ERVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1069 BRIANNA WAY, CHARLOTTE, NC 28217-1261
(704) 525-4069
(704) 525-4069
Mailing address
1069 BRIANNA WAY, CHARLOTTE, NC 28217-1261
(704) 525-4069
(704) 525-4069
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MHL-060-1010
NC
Other
Enumeration date
05/07/2007
Last updated
07/08/2007
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