Provider Demographics
NPI:1740519644
Name:GEWANT, MAVIS (CD, CLC)
Entity type:Individual
Prefix:MS
First Name:MAVIS
Middle Name:
Last Name:GEWANT
Suffix:
Gender:F
Credentials:CD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGH FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12440-5230
Mailing Address - Country:US
Mailing Address - Phone:845-616-1743
Mailing Address - Fax:
Practice Address - Street 1:157 CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:HIGH FALLS
Practice Address - State:NY
Practice Address - Zip Code:12440-5230
Practice Address - Country:US
Practice Address - Phone:845-616-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula