Individual
ROSS HERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, NP-C
Contact information
Practice address
213 NW 10TH ST, FAIRFIELD, IL 62837-1219
(618) 842-2611
Mailing address
213 NW 10TH ST STE A, FAIRFIELD, IL 62837-1219
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209018435
IL
Other
Enumeration date
08/24/2018
Last updated
11/08/2018
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