Individual
ERICA L HERTZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHN
Contact information
Practice address
1120 WAYZATA BLVD E STE 210, WAYZATA, MN 55391-1915
(320) 864-1236
Mailing address
1120 WAYZATA BLVD E STE 210, WAYZATA, MN 55391-1915
(952) 443-4600
(952) 443-4604
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
R-186114-1
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9957
MN
Other
Enumeration date
03/23/2018
Last updated
03/09/2023
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