Individual
KELLY GREENE GERVAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2001 VAIL AVE, CHARLOTTE, NC 28207-1219
(704) 304-5765
Mailing address
13950 CINNABAR PL, HUNTERSVILLE, NC 28078-5350
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
151865
NC
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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