Provider Demographics
NPI:1417955212
Name:HERGER, PAUL C (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:HERGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ELEMENTARY LN
Mailing Address - Street 2:
Mailing Address - City:PATRICK SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24133-3714
Mailing Address - Country:US
Mailing Address - Phone:276-694-7745
Mailing Address - Fax:
Practice Address - Street 1:18688 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1559
Practice Address - Country:US
Practice Address - Phone:276-694-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024152758367500000X
SCAPN 781367500000X
FLARNP 9168827367500000X
NCREC # 017940367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417955212Medicaid
VA021011W82Medicare PIN
VA012066W82Medicare PIN