Provider Demographics
NPI:1013694314
Name:HERDZINA, JOEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:HERDZINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2215
Mailing Address - Country:US
Mailing Address - Phone:405-810-6822
Mailing Address - Fax:405-810-6824
Practice Address - Street 1:540 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2215
Practice Address - Country:US
Practice Address - Phone:405-810-6822
Practice Address - Fax:405-810-6824
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172V00000XOther Service ProvidersCommunity Health Worker