Provider Demographics
NPI:1851822555
Name:HERTZ, ALTA MAY (BSN RN)
Entity Type:Individual
Prefix:
First Name:ALTA
Middle Name:MAY
Last Name:HERTZ
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 NE 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6957
Mailing Address - Country:US
Mailing Address - Phone:360-600-5727
Mailing Address - Fax:
Practice Address - Street 1:10330 SE 32ND AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6587
Practice Address - Country:US
Practice Address - Phone:503-416-1960
Practice Address - Fax:503-416-1959
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608176RN163W00000X
WARN60702554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse