Provider Demographics
NPI:1396242475
Name:HERSMAN, RENAE
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:HERSMAN
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 1:14 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9233
Mailing Address - Country:US
Mailing Address - Phone:740-788-8850
Mailing Address - Fax:740-788-8851
Practice Address - Street 1:14 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9233
Practice Address - Country:US
Practice Address - Phone:740-788-8850
Practice Address - Fax:740-788-8851
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator