Healthcare Provider Details

I. General information

NPI: 1922470574
Provider Name (Legal Business Name): JEFFREY HERSHBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WALES AVE NW STE 100
MASSILLON OH
44646-2323
US

IV. Provider business mailing address

3515 MASSILLON RD STE 300
UNIONTOWN OH
44685-7854
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-3188
  • Fax:
Mailing address:
  • Phone: 330-899-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18245-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: