Provider Demographics
NPI:1821812116
Name:HERNDON, MICHELLE MARY (MLT, (ASCP)CM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARY
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MLT, (ASCP)CM
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARY
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:566 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1148
Mailing Address - Country:US
Mailing Address - Phone:856-524-2323
Mailing Address - Fax:
Practice Address - Street 1:566 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1148
Practice Address - Country:US
Practice Address - Phone:856-524-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
66944246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3401146OtherCDC
66944OtherASCP