Provider Demographics
NPI:1649610973
Name:HERVERY, IRENE BURCH (RN)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:BURCH
Last Name:HERVERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 SHELTER CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-8169
Mailing Address - Country:US
Mailing Address - Phone:901-590-0763
Mailing Address - Fax:
Practice Address - Street 1:1652 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8557
Practice Address - Country:US
Practice Address - Phone:901-590-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker