Healthcare Provider Details

I. General information

NPI: 1275261679
Provider Name (Legal Business Name): ELIZABETH ANN HERZNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NILLES RD STE 5
FAIRFIELD OH
45014-7205
US

IV. Provider business mailing address

7456 SAXONY DR
WEST CHESTER OH
45069-2318
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-0347
  • Fax:
Mailing address:
  • Phone: 512-739-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: