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General NPI Number Information
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NPI Number | 1467230185
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Entity Type | Individual
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Provider Name | MICHELE LYNN GERVASE APRN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 07/06/2025
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Provider Practice Location Address
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Address Line | 64 MAPLE ST STE A
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City | KENT
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State | CT
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Zip | 06757-1721
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Country | US
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Telephone | 860-419-5925
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MAPLE ST STE A
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City | KENT
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State | CT
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Zip | 06757-1721
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Country | US
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Telephone | 631-455-9384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F07250255
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 176610
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License Number State | CT
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