Individual
MISS AISHA AMBER ERVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
920 GRAND AVE, SAN RAFAEL, CA 94901-3506
(415) 499-6426
Mailing address
729 SIR FRANCIS DRAKE BLVD, KENTFIELD, CA 94904-1627
(415) 258-0388
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
664991
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
664991
REGISTERED NURSE
CA
01
—
69495
PUBLIC HEALTH NURSE
CA
Enumeration date
10/17/2006
Last updated
07/08/2007
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