Provider Demographics
NPI:1821097312
Name:HERTZELL, RAMONA (CFM)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:HERTZELL
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STATE ST UNIT A
Mailing Address - Street 2:P.O. BOX 7968
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5659
Mailing Address - Country:US
Mailing Address - Phone:336-274-2003
Mailing Address - Fax:336-274-2052
Practice Address - Street 1:500 STATE ST.
Practice Address - Street 2:UNIT A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5659
Practice Address - Country:US
Practice Address - Phone:336-274-2003
Practice Address - Fax:336-274-2052
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60018665641744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4670290001Medicare NSC