Provider Demographics
NPI:1336132398
Name:HERTZ, LINDA RUTH (RN,CNS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RUTH
Last Name:HERTZ
Suffix:
Gender:F
Credentials:RN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ECHO ST
Mailing Address - Street 2:#406
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6156
Mailing Address - Country:US
Mailing Address - Phone:507-625-4060
Mailing Address - Fax:507-625-3915
Practice Address - Street 1:600 REED ST
Practice Address - Street 2:SUITE 115
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6410
Practice Address - Country:US
Practice Address - Phone:507-625-4060
Practice Address - Fax:507-625-3915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0349305364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN383R5HEOtherBLUE CROSS BLUE SHIELD MN
MN141429OtherUCARE
MN38251OtherHEALTH PARTNERS
MN38251OtherHEALTH PARTNERS