Provider Demographics
NPI:1407086135
Name:HERVAS, ELISABETH LEIGH (M E, ECSE)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:LEIGH
Last Name:HERVAS
Suffix:
Gender:F
Credentials:M E, ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1747
Mailing Address - Country:US
Mailing Address - Phone:708-387-0687
Mailing Address - Fax:
Practice Address - Street 1:3512 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1747
Practice Address - Country:US
Practice Address - Phone:708-387-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor