Healthcare Provider Details

I. General information

NPI: 1417955212
Provider Name (Legal Business Name): PAUL C HERGER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18688 JEB STUART HWY
STUART VA
24171-1559
US

IV. Provider business mailing address

22 ELEMENTARY LN
PATRICK SPRINGS VA
24133-3714
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-3151
  • Fax:
Mailing address:
  • Phone: 276-694-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024152758
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN 781
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9168827
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberREC # 017940
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: