Healthcare Provider Details

I. General information

NPI: 1336132398
Provider Name (Legal Business Name): LINDA RUTH HERTZ R.N.,C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 REED ST SUITE 115
MANKATO MN
56001-6410
US

IV. Provider business mailing address

115 ECHO ST #406
MANKATO MN
56001-6156
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-4060
  • Fax: 507-625-3915
Mailing address:
  • Phone: 507-625-4060
  • Fax: 507-625-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0349305
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: