MEDICARE: JONATHAN HERSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	17001260A	IN

General Provider Information

NPI Number	:	1063643161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN HERSEY

Provider Business Mailing Address
First Line	:	1714 NATIONAL RD W
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-3864
Country	:	US
Telephone Number	:	765-373-8105
Fax Number	:	765-373-8104

Provider Business Practice Location Address
First Line	:	1714 NATIONAL RD W
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-3864
Country	:	US
Telephone Number	:	765-373-8105
Fax Number	:	765-373-8104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	04/21/2022

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