1053889725 NPI number — ALLISON M HERSCHEDE RN, CDCES

Table of content: ALLISON M HERSCHEDE RN, CDCES (NPI 1053889725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053889725 NPI number — ALLISON M HERSCHEDE RN, CDCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERSCHEDE
Provider First Name:
ALLISON
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, CDCES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053889725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1036 HIGHWAY 72 EAST
Provider Second Line Business Mailing Address:
#1033
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35611-2823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-470-4383
Provider Business Mailing Address Fax Number:
866-411-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14811 CREEK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35613-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-470-4383
Provider Business Practice Location Address Fax Number:
866-411-5552
Provider Enumeration Date:
11/11/2018

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: 163WD0400X , with the licence number:  1-181285 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 905142 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WD0400X , with the licence number: 21800606 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1-181285 . This is a "REGISTERED NURSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 21800606 . This is a "CERTIFIED DIABETES EDUCATOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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