Provider Demographics
NPI:1639544281
Name:HEREK, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:HEREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 INDIAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48748-9626
Mailing Address - Country:US
Mailing Address - Phone:989-240-2570
Mailing Address - Fax:
Practice Address - Street 1:2313 INDIAN LAKE RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:MI
Practice Address - Zip Code:48748-9626
Practice Address - Country:US
Practice Address - Phone:989-240-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240765163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse