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Individual

ERVING WAYNE LONDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CNP

Contact information

Practice address
4600 LAKE ROAD AVE STE 301, ROBBINSDALE, MN 55422-1845
(763) 588-7099
(763) 522-2222
Mailing address
4600 LAKE ROAD AVE STE 301, ROBBINSDALE, MN 55422-1845
(763) 588-7099
(763) 522-2222

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0779645
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
894628100
MN
Enumeration date
04/26/2006
Last updated
02/21/2018
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