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NPI Code Detail

MEDICARE: TERESA J HERGERT N.P.

MEDICARE: TERESA J HERGERT N.P.
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
1363L00000XNurse Practitioner65204CO

General Provider Information

NPI Number : 1689728917
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA J HERGERT N.P.
Provider Business Mailing Address
First Line : 1010 N COUNTRY CLUB DR
Second Line :
City : MESA
State : AZ
Zip : 85201-3309
Country : US
Telephone Number : 480-461-2409
Fax Number :
Provider Business Practice Location Address
First Line : 1300 MAIN ST
Second Line :
City : WINDSOR
State : CO
Zip : 80550-5989
Country : US
Telephone Number : 970-686-5646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 11/23/2009

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Directions to “ TERESA J HERGERT N.P.” Practice Location

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