Provider Demographics
NPI:1194017780
Name:HERZ, PATRICA LINN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICA
Middle Name:LINN
Last Name:HERZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14129 ROAD 8
Mailing Address - Street 2:
Mailing Address - City:LODGEPOLE
Mailing Address - State:NE
Mailing Address - Zip Code:69149-2508
Mailing Address - Country:US
Mailing Address - Phone:308-249-6465
Mailing Address - Fax:308-377-2432
Practice Address - Street 1:14129 ROAD 8
Practice Address - Street 2:
Practice Address - City:LODGEPOLE
Practice Address - State:NE
Practice Address - Zip Code:69149-2508
Practice Address - Country:US
Practice Address - Phone:308-249-6465
Practice Address - Fax:308-377-2432
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11446164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse