Provider Demographics
NPI:1821417619
Name:HERSCH, LANESSA (RN)
Entity Type:Individual
Prefix:
First Name:LANESSA
Middle Name:
Last Name:HERSCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 28TH ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2325
Mailing Address - Country:US
Mailing Address - Phone:701-793-4369
Mailing Address - Fax:
Practice Address - Street 1:825 28TH ST S
Practice Address - Street 2:SUITE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2325
Practice Address - Country:US
Practice Address - Phone:701-793-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31877163WH0200X
MNR168292-2163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health