Provider Demographics
NPI:1285227611
Name:GERVON, KRISTA (CD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GERVON
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STONICKER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3215
Mailing Address - Country:US
Mailing Address - Phone:619-980-1369
Mailing Address - Fax:
Practice Address - Street 1:80 STONICKER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3215
Practice Address - Country:US
Practice Address - Phone:619-980-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula