Ermakov, Mavis Camalita

Ermakov, Mavis Camalita is an individual health care provider with primary practice located at 741 Broadway , Newark NJ 07104-4309. She recently has 4 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Dietitian, Registered, Dietary & Nutritional Service Providers / Nutrition, Metabolic, Nursing Service Providers / Diabetes Educator, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Ermakov, Mavis Camalita can be contacted via phone (973) 483-1300.

Contact Information

Primary practice address
741 Broadway Newark NJ 07104-4309
Phone: (973) 483-1300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 0071705 Illinois
Dietary & Nutritional Service Providers / Nutrition, Metabolic 133VN1006X 717052 (ID#) Illinois
Nursing Service Providers / Diabetes Educator 163WD0400X 26NR112011600 New Jersey
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 26NJ00421400 New Jersey

Profile Details

NPI number 1265614911
LBN Legal business name Ermakov, Mavis Camalita
Credentials R.D., RN., CDE., APN
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 4th, 2007
Last updated Aug 17th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265614911 NPPES
New Jersey MEDICAID 0143533620

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