Healthcare Provider Details

I. General information

NPI: 1548621121
Provider Name (Legal Business Name): KRISTEN GERVASI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 GOVERNORS HWY
FLOSSMOOR IL
60422-2125
US

IV. Provider business mailing address

19550 GOVERNORS HWY
FLOSSMOOR IL
60422-2125
US

V. Phone/Fax

Practice location:
  • Phone: 708-915-3100
  • Fax:
Mailing address:
  • Phone: 708-915-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.002075
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: