Provider Demographics
NPI:1548484751
Name:HEMMELGARN, VIVIAN D
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:D
Last Name:HEMMELGARN
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:NORTH STAR
Mailing Address - State:OH
Mailing Address - Zip Code:45350-0007
Mailing Address - Country:US
Mailing Address - Phone:419-336-6011
Mailing Address - Fax:
Practice Address - Street 1:68 E STAR RD
Practice Address - Street 2:
Practice Address - City:ROSSBURG
Practice Address - State:OH
Practice Address - Zip Code:45362
Practice Address - Country:US
Practice Address - Phone:419-336-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2520258Medicare UPIN