Provider Demographics
NPI:1013391671
Name:ANGELA L HERGET
Entity Type:Organization
Organization Name:ANGELA L HERGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT #15856 / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HERGET
Authorized Official - Suffix:
Authorized Official - Credentials:LMT CA
Authorized Official - Phone:541-948-7090
Mailing Address - Street 1:810 NW TEAK AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1234
Mailing Address - Country:US
Mailing Address - Phone:541-948-7090
Mailing Address - Fax:
Practice Address - Street 1:716 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2648
Practice Address - Country:US
Practice Address - Phone:541-948-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty