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General NPI Number Information
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NPI Number | 1063643161
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Entity Type | Individual
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Provider Name | JONATHAN HERSEY
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Gender | Male
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 1714 NATIONAL RD W
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City | RICHMOND
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State | IN
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Zip | 47374-3864
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Country | US
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Telephone | 765-373-8105
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Fax | 765-373-8104
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Provider Business Mailing Address
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Address Line | 1714 NATIONAL RD W
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City | RICHMOND
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State | IN
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Zip | 47374-3864
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Country | US
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Telephone | 765-373-8105
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Fax | 765-373-8104
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 17001260A
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License Number State | IN
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