Healthcare Provider Details

I. General information

NPI: 1740476548
Provider Name (Legal Business Name): GRACE ANASTASIA HERWIG RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE FOCHTMAN HERWIG RN, APN

II. Dates (important events)

Enumeration Date: 09/15/2007
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26027 COBBLESTONE WAY
WESTLAKE OH
44145-2459
US

IV. Provider business mailing address

26027 COBBLESTONE WAY
WESTLAKE OH
44145-2459
US

V. Phone/Fax

Practice location:
  • Phone: 440-360-9306
  • Fax: 440-808-8860
Mailing address:
  • Phone: 440-212-8045
  • Fax: 440-808-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN 099780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: