Basic Information
| Provider Information | |||||||||
| NPI: | 1902904790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERTWIG | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | PATRICE | ||||||||
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| Credential: | CPNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HERTWIG | ||||||||
| OtherFirstName: | RHONDA | ||||||||
| OtherMiddleName: | PATRICE | ||||||||
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| OtherCredential: | CPNP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 46 WILD DEER TRL | ||||||||
| Address2: | |||||||||
| City: | ZIRCONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287908988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286938396 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 CHADWICK SQUARE CT STE A | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287393238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286988135 | ||||||||
| FaxNumber: | 8286988518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 5004208 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | 3626 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.