Basic Information
| Provider Information | |||||||||
| NPI: | 1497012504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERBERT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6635 LONG RD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380029673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012121508 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 106851 | TN | Y | Nursing Service Providers | Registered Nurse |
No ID Information.