MEDICARE: GERVIS EDWARDS

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	163W00000X	Registered Nurse	559597-1	NY

General Provider Information

NPI Number	:	1942477252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERVIS EDWARDS

Provider Business Mailing Address
First Line	:	675 E 170TH ST
Second Line	:	APT. 1E
City	:	BRONX
State	:	NY
Zip	:	10456-2341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 E 170TH ST
Second Line	:	APT. 1E
City	:	BRONX
State	:	NY
Zip	:	10456-2341
Country	:	US
Telephone Number	:	718-328-6926
Fax Number	:

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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