1437467453 NPI number — MRS. CHRISTINA VERONICA HERICKS ANP-BC

Table of content: MRS. CHRISTINA VERONICA HERICKS ANP-BC (NPI 1437467453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437467453 NPI number — MRS. CHRISTINA VERONICA HERICKS ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERICKS
Provider First Name:
CHRISTINA
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYEAS
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
VERONICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437467453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10701 EAST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44106-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-791-3800
Provider Business Mailing Address Fax Number:
216-229-2636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10701 EAST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44106-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-791-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  RN333391 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)