Provider Demographics
NPI:1518262641
Name:HAYSMAN COHEN, HERCHELLE (ANP-BC)
Entity Type:Individual
Prefix:MISS
First Name:HERCHELLE
Middle Name:
Last Name:HAYSMAN COHEN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:HERCHELLE
Other - Middle Name:
Other - Last Name:HAYSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:565 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4308
Mailing Address - Country:US
Mailing Address - Phone:770-995-5131
Mailing Address - Fax:770-995-3482
Practice Address - Street 1:565 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4308
Practice Address - Country:US
Practice Address - Phone:770-995-5131
Practice Address - Fax:770-995-3482
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204554363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health