MEDICARE: DAWN ANNETTE GERVIN-ISLER CNM

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	367A00000X	Advanced Practice Midwife	25ME00039201	NJ
2	367A00000X	Advanced Practice Midwife	RN213245	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407817182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN ANNETTE GERVIN-ISLER CNM

Provider Business Mailing Address
First Line	:	771 OLD NORCROSS RD
Second Line	:	SUITE 350
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4386
Country	:	US
Telephone Number	:	678-380-1200
Fax Number	:	678-380-7494

Provider Business Practice Location Address
First Line	:	771 OLD NORCROSS RD
Second Line	:	SUITE 350
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4386
Country	:	US
Telephone Number	:	678-380-1200
Fax Number	:	678-380-7494

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	09/05/2014

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