Provider Demographics
NPI:1871049106
Name:ERVIN, DEVON (MS)
Entity type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 S. CEDAR CREAST BLVD
Mailing Address - Street 2:414
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-404-1390
Mailing Address - Fax:610-402-2754
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:414
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6369
Practice Address - Country:US
Practice Address - Phone:610-404-1390
Practice Address - Fax:610-402-2754
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPGC000035170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS