Provider Demographics
NPI:1942795612
Name:HERRON, EDWINA RENEE
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:RENEE
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDWINA
Other - Middle Name:RENEE
Other - Last Name:HOLSCHBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 W LONG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2815
Mailing Address - Country:US
Mailing Address - Phone:614-225-0991
Mailing Address - Fax:614-225-0991
Practice Address - Street 1:16 W LONG ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2815
Practice Address - Country:US
Practice Address - Phone:614-225-0991
Practice Address - Fax:614-225-0991
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator