Provider Demographics
NPI:1124628995
Name:HERBRANSON, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HERBRANSON
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 1:1007 7TH AVE N APT C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4326
Mailing Address - Country:US
Mailing Address - Phone:218-341-7847
Mailing Address - Fax:
Practice Address - Street 1:1007 7TH AVE N APT C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4326
Practice Address - Country:US
Practice Address - Phone:218-341-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant