Provider Demographics
NPI:1396255915
Name:HERZBERG, LILLIAN DRUSHELIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DRUSHELIA
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37450 SCHOOLCRAFT RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1000
Mailing Address - Country:US
Mailing Address - Phone:734-458-4601
Mailing Address - Fax:
Practice Address - Street 1:26827 ANNAPOLIS ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1201
Practice Address - Country:US
Practice Address - Phone:313-303-8887
Practice Address - Fax:313-303-8887
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704188154163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse