Provider Demographics
NPI:1003539438
Name:GERVAIS, LEIGHSA M (MED, BSN, RN, NCSN)
Entity Type:Individual
Prefix:MRS
First Name:LEIGHSA
Middle Name:M
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:MED, BSN, RN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W OCTAVE ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4075
Mailing Address - Country:US
Mailing Address - Phone:509-543-6792
Mailing Address - Fax:509-546-2698
Practice Address - Street 1:1616 W OCTAVE ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4075
Practice Address - Country:US
Practice Address - Phone:509-543-6792
Practice Address - Fax:509-546-2698
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00127768163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool