Provider Demographics
NPI:1851251649
Name:HERVERT, PAULA ANN
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:HERVERT
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 1:136 GREENWAY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9478
Mailing Address - Country:US
Mailing Address - Phone:989-327-8166
Mailing Address - Fax:
Practice Address - Street 1:136 GREENWAY VIEW CT
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-9478
Practice Address - Country:US
Practice Address - Phone:989-327-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse