Provider Demographics
NPI:1902678808
Name:GERVACIO, CHARISSE SHEENY (RN)
Entity Type:Individual
Prefix:
First Name:CHARISSE SHEENY
Middle Name:
Last Name:GERVACIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W HERSCHEL ST
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-3512
Mailing Address - Country:US
Mailing Address - Phone:609-412-4644
Mailing Address - Fax:609-593-6061
Practice Address - Street 1:427 W HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-3512
Practice Address - Country:US
Practice Address - Phone:609-412-4644
Practice Address - Fax:609-593-6061
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR25160900163WD1100X, 163WH0200X, 163WI0500X, 163WN0300X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Multi-Specialty
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WN0300XNursing Service ProvidersRegistered NurseNephrologyGroup - Multi-Specialty