Individual
SUSAN H GERVASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHCNP, BSN
Contact information
Practice address
10100 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 786-8435
Mailing address
13683 SE 127TH AVE, CLACKAMAS, OR 97015-7302
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
OR 083042345N7
OR
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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