Provider Demographics
NPI:1730653833
Name:CLERVOIX, GUIRLENE S
Entity Type:Individual
Prefix:
First Name:GUIRLENE
Middle Name:S
Last Name:CLERVOIX
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 1:2 MALLORY CT
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-8852
Mailing Address - Country:US
Mailing Address - Phone:718-791-1839
Mailing Address - Fax:
Practice Address - Street 1:2 MALLORY CT
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-8852
Practice Address - Country:US
Practice Address - Phone:718-791-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily