Provider Demographics
NPI:1740476548
Name:HERWIG, GRACE ANASTASIA (RN, APN)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ANASTASIA
Last Name:HERWIG
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:FOCHTMAN
Other - Last Name:HERWIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, APN
Mailing Address - Street 1:26027 COBBLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2459
Mailing Address - Country:US
Mailing Address - Phone:440-212-8045
Mailing Address - Fax:440-808-8860
Practice Address - Street 1:27101 E OVIATT RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-3307
Practice Address - Country:US
Practice Address - Phone:440-360-9306
Practice Address - Fax:440-808-8860
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 099780364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHENS 00661Medicare PIN