MEDICARE: MONICA GERVAIS ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	COA.12891-NP	OH

General Provider Information

NPI Number	:	1104130251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA GERVAIS ANP-BC

Provider Business Mailing Address
First Line	:	10685 CARNEGIE AVE # X20
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10685 CARNEGIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:	216-444-6568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2010
Last Update Date	:	07/08/2024

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