MEDICARE: HERNETH PARK RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN602175	PA

General Provider Information

NPI Number	:	1841993813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERNETH PARK RN

Provider Business Mailing Address
First Line	:	1331 WAYNE ST
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5955
Country	:	US
Telephone Number	:	551-404-4817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 WAYNE ST
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5955
Country	:	US
Telephone Number	:	551-404-4817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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