1356830384 NPI number — MR. LOUIS E HERZOG NURSE PRACTITIONER

Table of content: MR. LOUIS E HERZOG NURSE PRACTITIONER (NPI 1356830384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356830384 NPI number — MR. LOUIS E HERZOG NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERZOG
Provider First Name:
LOUIS
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
M

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:
1356830384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70802-6929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-255-3776
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7210 MURRAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-373-2800
Provider Business Practice Location Address Fax Number:
209-373-2878
Provider Enumeration Date:
05/04/2018

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: 163WP0809X , with the licence number:  RN140980 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP10024 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: NP95009654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP10024 . This is a "LOUISIANA STATE BOARD OF NURSING" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: RN140980 . This is a "WAITING ON LICENSE FOR NP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2017037465 . This is a "PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP95009654 . This is a "CALIFORNIA STATE BOARD OF NURSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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