Provider Demographics
NPI:1891771069
Name:HERMAN, LYNN M (CRNA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:HERMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DRIVE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:311 STRAIGHT ST
Practice Address - Street 2:MILLENIUM ANESTHESIA LLC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000189747OtherANTHEM BLUE SHIELD
000000230809OtherANTHEM BLUE SHIELD
OH0738867Medicaid
KY74387754Medicaid
728010OtherBUCKEYE
000000189747OtherANTHEM BLUE SHIELD
728010OtherBUCKEYE
OHHE8229892Medicare ID - Type Unspecified