Provider Demographics
NPI:1821455148
Name:HERTSENS, AMETHYST (CLC)
Entity Type:Individual
Prefix:
First Name:AMETHYST
Middle Name:
Last Name:HERTSENS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2903
Mailing Address - Country:US
Mailing Address - Phone:917-858-1754
Mailing Address - Fax:
Practice Address - Street 1:38 W 36TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2903
Practice Address - Country:US
Practice Address - Phone:917-858-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN