Provider Demographics
NPI:1194995803
Name:CERVERA, ERICA RENNEE (RN, MSN, APRN, BC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:RENNEE
Last Name:CERVERA
Suffix:
Gender:F
Credentials:RN, MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-2116
Mailing Address - Country:US
Mailing Address - Phone:304-442-5151
Mailing Address - Fax:304-442-7494
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-5151
Practice Address - Fax:304-442-7494
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CENP26531Medicare PIN