Provider Demographics
NPI:1477901684
Name:HERSI, HERSI
Entity Type:Individual
Prefix:MR
First Name:HERSI
Middle Name:
Last Name:HERSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 S GEYER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1237
Mailing Address - Country:US
Mailing Address - Phone:858-752-7052
Mailing Address - Fax:
Practice Address - Street 1:3636 S GEYER RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1237
Practice Address - Country:US
Practice Address - Phone:858-752-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care