Provider Demographics
NPI:1497044192
Name:GERVACIO, TONYA SUE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:SUE
Last Name:GERVACIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 150TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-8437
Mailing Address - Country:US
Mailing Address - Phone:253-232-5952
Mailing Address - Fax:
Practice Address - Street 1:8012 150TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-8437
Practice Address - Country:US
Practice Address - Phone:253-232-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula