Provider Demographics
NPI:1962413039
Name:HERMAN, TERESA IRENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:IRENE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 SCHROEDER ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2046
Mailing Address - Country:US
Mailing Address - Phone:419-810-3510
Mailing Address - Fax:419-475-9701
Practice Address - Street 1:2604 SCHROEDER ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2046
Practice Address - Country:US
Practice Address - Phone:419-810-3510
Practice Address - Fax:419-475-9701
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 114788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2458497Medicare UPIN