Herzog, Shanti Elizabeth

Herzog, Shanti Elizabeth is an individual health care provider with primary practice located at 6334 Littlerock Rd Sw , Tumwater WA 98512-7332. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Herzog, Shanti Elizabeth can be contacted via phone (360) 704-7590.

Contact Information

Primary practice address
6334 Littlerock Rd Sw Tumwater WA 98512-7332
Phone: (360) 704-7590
Fax: (360) 704-7591
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP60791095 Washington

Profile Details

NPI number 1770959025
LBN Legal business name Herzog, Shanti Elizabeth
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2015
Last updated Dec 11th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770959025 NPPES
Oregon MEDICAID 22959
Oregon MEDICAID 096511

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