Provider Demographics
NPI:1467230185
Name:GERVASE, MICHELE LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:GERVASE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MAPLE ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1721
Mailing Address - Country:US
Mailing Address - Phone:631-455-9384
Mailing Address - Fax:
Practice Address - Street 1:64 MAPLE ST STE A
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1721
Practice Address - Country:US
Practice Address - Phone:860-419-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTF07250255363LF0000X
CT176610163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine