Provider Demographics
NPI:1518175744
Name:HERGATT, ROBIN GAIL (LPN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:GAIL
Last Name:HERGATT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9704
Mailing Address - Country:US
Mailing Address - Phone:330-483-0172
Mailing Address - Fax:
Practice Address - Street 1:1167 W RIVER RD
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:OH
Practice Address - Zip Code:44280-9704
Practice Address - Country:US
Practice Address - Phone:330-483-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN083403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2696220Medicaid