1740476548 NPI number — MRS. GRACE ANASTASIA HERWIG RN, APN

Table of content: MRS. GRACE ANASTASIA HERWIG RN, APN (NPI 1740476548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740476548 NPI number — MRS. GRACE ANASTASIA HERWIG RN, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERWIG
Provider First Name:
GRACE
Provider Middle Name:
ANASTASIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERWIG
Provider Other First Name:
GRACE
Provider Other Middle Name:
FOCHTMAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, APN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740476548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26027 COBBLESTONE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-212-8045
Provider Business Mailing Address Fax Number:
440-808-8860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27101 E OVIATT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44140-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-360-9306
Provider Business Practice Location Address Fax Number:
440-808-8860
Provider Enumeration Date:
09/15/2007

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: 364SP0809X , with the licence number:  RN 099780 , 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)





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