Provider Demographics
NPI:1982904462
Name:HIRSCH, JULIANNA (LPN)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45370-0126
Mailing Address - Country:US
Mailing Address - Phone:937-673-8887
Mailing Address - Fax:
Practice Address - Street 1:3921 CORNSTALK RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-8959
Practice Address - Country:US
Practice Address - Phone:937-673-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142419-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN.142419-M-IVOtherNURSE LPN