Organization
MIDWEST MENTAL HEALTH CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUALINE GERVAIS PMHNP (OWNER)
(218) 477-1353
Entity
Organization
Contact information
Practice address
1122 1ST AVE N, FARGO, ND 58102-4604
(218) 477-1353
(218) 477-1354
Mailing address
819 30TH AVE S OFFICE 206 SUITE B, MOORHEAD, MN 56560
(218) 477-1353
(218) 477-1354
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP3899
MN
Other
Enumeration date
07/29/2015
Last updated
01/17/2023
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