Healthcare Provider Details

I. General information

NPI: 1912048950
Provider Name (Legal Business Name): BONNIE L HERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BONNIE L HERT RN

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N6185 SCHOOL CREEK TRL
LUXEMBURG WI
54217-1035
US

IV. Provider business mailing address

N4420 COUNTY ROAD C
PULASKI WI
54162-7619
US

V. Phone/Fax

Practice location:
  • Phone: 920-845-2128
  • Fax:
Mailing address:
  • Phone: 715-758-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: