Healthcare Provider Details

I. General information

NPI: 1164311437
Provider Name (Legal Business Name): RACHEL HERWERTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 CONANT ST
BEVERLY MA
01915-1672
US

IV. Provider business mailing address

1678 ASYLUM AVE
WEST HARTFORD CT
06117-2764
US

V. Phone/Fax

Practice location:
  • Phone: 978-691-5690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: