Provider Demographics
NPI:1538745112
Name:HERBST, TERRY W (RN)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:W
Last Name:HERBST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ENTERPRISE BLVD APT 5303
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8548
Mailing Address - Country:US
Mailing Address - Phone:803-315-5881
Mailing Address - Fax:
Practice Address - Street 1:650 ENTERPRISE BLVD APT 5303
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8548
Practice Address - Country:US
Practice Address - Phone:803-315-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC74196163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health