Individual
ANTONIO SAMUEL GERVAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA, RN
Contact information
Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 913-3043
Mailing address
499 N 880 E, SPRINGVILLE, UT 84663-1156
(801) 687-8382
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
310047
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
134946
NC
Other
Enumeration date
08/27/2020
Last updated
08/27/2020
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