Provider Demographics
NPI:1073193314
Name:GERVAIS, ANNA ROSE (DO)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ROSE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7690
Mailing Address - Country:US
Mailing Address - Phone:716-961-8135
Mailing Address - Fax:
Practice Address - Street 1:12 HIGH ST STE 301
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7690
Practice Address - Country:US
Practice Address - Phone:716-961-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDO4095207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program