Individual
MS. LISA L GERVASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1604 BENTON AVE, BENTON, ME 04901-3327
(207) 453-4708
(207) 453-6250
Mailing address
121 BACK WINTERPORT RD, HAMPDEN, ME 04444
(207) 852-7192
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R057352
ME
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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