Provider Demographics
NPI:1356830384
Name:HERZOG, LOUIS E (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:E
Last Name:HERZOG
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-6929
Mailing Address - Country:US
Mailing Address - Phone:985-255-3776
Mailing Address - Fax:
Practice Address - Street 1:7210 MURRAY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210
Practice Address - Country:US
Practice Address - Phone:209-373-2800
Practice Address - Fax:209-373-2878
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN140980163WP0809X
LAAP10024363LP0808X
CANP95009654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP10024OtherLOUISIANA STATE BOARD OF NURSING
LARN140980OtherWAITING ON LICENSE FOR NP
2017037465OtherPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER
CANP95009654OtherCALIFORNIA STATE BOARD OF NURSING