Provider Demographics
NPI:1821176272
Name:HERTHER, DEBORAH (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HERTHER
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3958 S STATE ROAD 235
Mailing Address - Street 2:
Mailing Address - City:VALLONIA
Mailing Address - State:IN
Mailing Address - Zip Code:47281-9512
Mailing Address - Country:US
Mailing Address - Phone:812-358-4096
Mailing Address - Fax:
Practice Address - Street 1:2415 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4731
Practice Address - Country:US
Practice Address - Phone:812-279-6222
Practice Address - Fax:812-277-0418
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001282A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ51040Medicare UPIN