Provider Demographics
NPI:1487724043
Name:HERSHNER, JAN CAROLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:CAROLE
Last Name:HERSHNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:380 BUCKS LANE
Mailing Address - City:WARRENSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28693-0283
Mailing Address - Country:US
Mailing Address - Phone:336-384-4734
Mailing Address - Fax:336-384-4734
Practice Address - Street 1:380 BUCKS LN
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28693-0283
Practice Address - Country:US
Practice Address - Phone:338-384-4734
Practice Address - Fax:336-384-4734
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301933Medicaid