MEDICARE: LANESSA HERSCH RN

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	163WH0200X	Home Health Registered Nurse	R31877	ND
2	163WH0200X	Home Health Registered Nurse	R168292-2	MN

General Provider Information

NPI Number	:	1821417619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANESSA HERSCH RN

Provider Business Mailing Address
First Line	:	825 28TH ST S
Second Line	:	SUITE A
City	:	FARGO
State	:	ND
Zip	:	58103-2325
Country	:	US
Telephone Number	:	701-793-4369
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 28TH ST S
Second Line	:	SUITE A
City	:	FARGO
State	:	ND
Zip	:	58103-2325
Country	:	US
Telephone Number	:	701-793-4369
Fax Number	:

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	05/30/2014

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