MEDICARE: GAIL ANN HERD

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1174110662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL ANN HERD

Provider Business Mailing Address
First Line	:	3897 GRENVILLE RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3775
Country	:	US
Telephone Number	:	216-526-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3897 GRENVILLE RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3775
Country	:	US
Telephone Number	:	216-526-0107
Fax Number	:

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ GAIL ANN HERD ” Practice Location

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