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SHANTI ELIZABETH HERZOG FNP
NPI 1770959025
Nurse Practitioner - Family in Tumwater, WA

Active since August 20, 2015Opted out of Medicare · through Apr 1, 2027
6334 LITTLEROCK RD SW, TUMWATER, WA 98512(360) 704-7590(360) 704-7591 Get Directions Write a Review

NPPES record last updated: December 11, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 11, 2020, Jan 8, 2018 (2 updates tracked since 2018).

About Shanti Elizabeth Herzog Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANTI ELIZABETH HERZOG FNP (NPI 1770959025) is an individual family provider in Tumwater, Washington, licensed in Washington (AP60791095) and active in the NPI registry since August 2015. She has opted out of Medicare through April 1, 2027.

NPPES Registry Identity

NPI1770959025
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameSHANTI ELIZABETH HERZOGCredential: FNP
Location Address6334 LITTLEROCK RD SWTumwater, WA 98512-7332
Mailing Address2101 E Yesler Way, Ste 210Seattle, WA 98122-5959 · (503) 988-7468 · Fax (503) 988-3015
Phone(360) 704-7590
Fax(360) 704-7591
Sole ProprietorNo
Enumeration DateAugust 20, 2015
Last NPPES UpdateDecember 11, 20202 updates tracked since enumeration
NPPES CertifiedDecember 11, 2020
✔ NPI 1770959025 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in WA · AP60791095
6334 LITTLEROCK RD SW, Tumwater, WA 98512
Open in Google Maps ↗

Other Identifiers 2

Medicaid22959OR
Medicaid096511OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Shanti Elizabeth Herzog Fnp has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2025 through April 1, 2027.

Opt-Out Effective DateApril 1, 2025
Opt-Out In Effect ThroughApril 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. HOLLY NOELLE HEIAN L.M.P.
Massage Therapist
6334 LITTLEROCK RD SW, BLDG 6, SUITE 101
TUMWATER, WA 98512
Thurston County (360) 359-2162
PHYSIOTHERAPY ASSOCIATES INC
Clinic/Center (Physical Therapy)
6334 LITTLEROCK RD SW, SUITE 103
TUMWATER, WA 98512
Thurston County (360) 786-0878
MR. DOUGLAS ANDREW STENCHEVER SUDP
Counselor (Addiction (Substance Use Disorder))
6334 LITTLEROCK RD SW
TUMWATER, WA 98512
Thurston County (360) 704-7590
IDUAR DEREIX CALONGE
Counselor (Mental Health)
6334 LITTLEROCK RD SW
TUMWATER, WA 98512
Thurston County (360) 704-7590
GILBERTO MALDONADO LICSWA, CDPT
Social Worker (Clinical)
6334 LITTLEROCK RD SW
TUMWATER, WA 98512
Thurston County (360) 704-7590
MARY NJOGU
Nurse Practitioner (Psychiatric/Mental Health)
6334 LITTLEROCK RD SW
TUMWATER, WA 98512
Thurston County (360) 704-7590
MISS LORELIE CACERES LIGASAN M.S., LMHC
Counselor (Mental Health)
6334 LITTLEROCK RD SW
TUMWATER, WA 98512
Thurston County (360) 704-7590
DR. KAE K STARR LMFTA LMFTA
Counselor
6334 LITTLEROCK RD SW
TUMWATER, WA 98512
Thurston County (360) 704-7590

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shanti Herzog's NPI number?

The NPI number for Shanti Herzog is 1770959025. It was assigned to this individual provider in the NPPES registry on August 20, 2015.

Where is Shanti Herzog located?

Shanti Herzog practices at 6334 Littlerock Rd SW, Tumwater, WA 98512. The listed phone number is (360) 704-7590.

What is Shanti Herzog's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Shanti Herzog enrolled in Medicare?

No. Shanti Herzog has opted out of Medicare through April 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Shanti Herzog accept?

Health plans from PacificSource Health Plans and Premera Blue Cross Blue Shield of Alaska list Shanti Herzog as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shanti Herzog was last updated on December 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.