Provider Demographics
NPI:1053889725
Name:HERSCHEDE, ALLISON M (RN, CDCES)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:HERSCHEDE
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 HIGHWAY 72 EAST
Mailing Address - Street 2:#1033
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2823
Mailing Address - Country:US
Mailing Address - Phone:954-470-4383
Mailing Address - Fax:866-411-5552
Practice Address - Street 1:14811 CREEK LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2823
Practice Address - Country:US
Practice Address - Phone:954-470-4383
Practice Address - Fax:866-411-5552
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-181285163WD0400X
TX905142163W00000X
TX21800606163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-181285OtherREGISTERED NURSE
TX21800606OtherCERTIFIED DIABETES EDUCATOR