MEDICARE: CATHERINE HEREK

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	163W00000X	Registered Nurse	4704240765	MI

General Provider Information

NPI Number	:	1639544281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE HEREK

Provider Business Mailing Address
First Line	:	2313 INDIAN LAKE RD
Second Line	:
City	:	NATIONAL CITY
State	:	MI
Zip	:	48748-9626
Country	:	US
Telephone Number	:	989-240-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 INDIAN LAKE RD
Second Line	:
City	:	NATIONAL CITY
State	:	MI
Zip	:	48748-9626
Country	:	US
Telephone Number	:	989-240-2570
Fax Number	:

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

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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Directions to “ CATHERINE HEREK ” Practice Location

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