Individual
GARY LAVERNE SEVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
2925 JOHNSON AVE NW TRLR 50, CEDAR RAPIDS, IA 52405-4676
(319) 981-3617
Mailing address
2925 JOHNSON AVE NW TRLR 50, CEDAR RAPIDS, IA 52405-4676
(319) 981-3617
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
087661
IA
163WI0500X
Infusion Therapy Registered Nurse
087661
IA
Other
Enumeration date
01/22/2010
Last updated
01/22/2010
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