Provider Demographics
NPI:1407817182
Name:GERVIN-ISLER, DAWN ANNETTE (CNM)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ANNETTE
Last Name:GERVIN-ISLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:678-380-1200
Mailing Address - Fax:678-380-7494
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 350
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:678-380-1200
Practice Address - Fax:678-380-7494
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00039201367A00000X
GARN213245367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1126407Medicaid