Provider Demographics
NPI:1538179643
Name:HERMAN, CONSTANCE A (FNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:HERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3628
Mailing Address - Country:US
Mailing Address - Phone:530-257-2452
Mailing Address - Fax:530-251-5208
Practice Address - Street 1:795 JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3628
Practice Address - Country:US
Practice Address - Phone:530-257-2542
Practice Address - Fax:530-251-5208
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
051947Medicare ID - Type UnspecifiedDFP
942492609OtherTAX ID NUMBER
051806Medicare ID - Type UnspecifiedWFP
CAFHC70292FMedicaid
CAFHC03843FMedicaid
CAFHC70081FMedicaid
051008Medicare ID - Type UnspecifiedNHC