Provider Demographics
NPI:1295948628
Name:HERGET, DELORIS KAY
Entity type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:KAY
Last Name:HERGET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-7638
Mailing Address - Country:US
Mailing Address - Phone:740-377-9322
Mailing Address - Fax:
Practice Address - Street 1:7734 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7822
Practice Address - Country:US
Practice Address - Phone:740-894-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2704541Medicaid