Provider Demographics
NPI:1235191941
Name:HERSCHELMAN, MICHELLE D (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:HERSCHELMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24776
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-4776
Mailing Address - Country:US
Mailing Address - Phone:877-288-1799
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-983-7211
Practice Address - Fax:865-983-8043
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002009396367500000X
VA0001229574367500000X
TN11056367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100047351OtherPHP TENNCARE
TN4102268OtherBLUE CROSS
TNP00258740OtherTRAVELERS MEDICARE
TN3634482Medicaid
MO915470207Medicaid
MO786102OtherHEALTHLINK
MO127254OtherBLUE SHIELD
TN4102268OtherBLUECARE
TN100047351OtherPHP TENNCARE
MO127254OtherBLUE SHIELD
TN4102268OtherBLUECARE
MO833525236Medicare PIN