Individual
AMANDA GERVAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
464 RIVER RD, ANDOVER, MA 01810-4260
(978) 569-3164
Mailing address
464 RIVER RD, ANDOVER, MA 01810-4260
(978) 569-3164
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN63437
MA
Other
Enumeration date
04/08/2021
Last updated
04/08/2021
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