Provider Demographics
NPI:1134109002
Name:HERTZFELD, KIMBERLY JEAN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:HERTZFELD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:STE 220
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-5357
Mailing Address - Country:US
Mailing Address - Phone:419-517-7600
Mailing Address - Fax:419-571-7598
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3536
Practice Address - Country:US
Practice Address - Phone:419-517-4600
Practice Address - Fax:419-517-7598
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247245367A00000X
OHNM05925367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191819Medicaid
OHH139090Medicare PIN
OHP15070Medicare UPIN