Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 020056498 | IN |
Y | 2084N0402X | Child Neurologist | 75079 | WI |
NPI | 1346653284 |
---|---|
Provider Name | Whitney Leigh Gervelis |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 08/07/2021 |