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General NPI Number Information
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NPI Number | 1053548727
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Entity Type | Individual
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Provider Name | JOHN C HERGERT CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 160 ALLEN STREET
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City | RUTLAND
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State | VT
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Zip | 05701
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Country | US
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Telephone | 802-747-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 HARRISON PKWY SUITE 200 MAILSTOP SH-9A
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City | SUNRISE
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State | FL
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Zip | 33323-2896
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Country | US
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Telephone | 954-838-2371
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Fax | 954-851-1746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101-0054298
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License Number State | VT
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