Healthcare Provider Details

I. General information

NPI: 1184475055
Provider Name (Legal Business Name): MARY ANNE G HERKERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S EASTERN AVE
LAS VEGAS NV
89119-0810
US

IV. Provider business mailing address

7640 EASTHAM BAY AVE
LAS VEGAS NV
89179-1440
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-0300
  • Fax:
Mailing address:
  • Phone: 307-220-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN66617
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN66617
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN66617
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: