Individual
MR. JEREMY RICHARD HERR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, FNP, APNP
Contact information
Practice address
770 KENMOOR AVE SE STE 100, GRAND RAPIDS, MI 49546-8602
(616) 272-3533
(616) 259-4839
Mailing address
801 ROSEHILL RD, JACKSON, MI 49202-1762
(517) 212-2008
(517) 212-2009
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
154692-030
WI
163W00000X
Registered Nurse
3903890
MI
363L00000X
Nurse Practitioner
4704314515
MI
363LF0000X
Family Nurse Practitioner
3920511
MI
363LF0000X
Family Nurse Practitioner
4211-33
WI
363LF0000X
Family Nurse Practitioner
Primary
4704314515
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D16078176
MEDICARE PTAN
MI
Enumeration date
10/01/2010
Last updated
03/16/2023
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