Provider Demographics
NPI:1275842650
Name:HERZ, DEBRA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HERZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MIDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1274
Mailing Address - Country:US
Mailing Address - Phone:815-223-2808
Mailing Address - Fax:815-220-2691
Practice Address - Street 1:1650 MIDTOWN RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1274
Practice Address - Country:US
Practice Address - Phone:815-223-2808
Practice Address - Fax:815-220-2691
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily