Provider Demographics
NPI:1215776117
Name:HERCZEG, KATHARINE GRIFFIN
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:GRIFFIN
Last Name:HERCZEG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BRIARCLIFF TRL
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4611
Mailing Address - Country:US
Mailing Address - Phone:920-728-7602
Mailing Address - Fax:
Practice Address - Street 1:1140 BRIARCLIFF TRL
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4611
Practice Address - Country:US
Practice Address - Phone:920-728-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133N00000XDietary & Nutritional Service ProvidersNutritionist