Provider Demographics
NPI:1548608771
Name:HERMAN, DONELLA LYNN (MD)
Entity type:Individual
Prefix:
First Name:DONELLA
Middle Name:LYNN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONELLA
Other - Middle Name:LYNN
Other - Last Name:HEADLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1210 W 18TH ST STE G01
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4651
Mailing Address - Country:US
Mailing Address - Phone:605-328-2663
Mailing Address - Fax:605-328-3760
Practice Address - Street 1:1210 W 18TH ST STE G01
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4651
Practice Address - Country:US
Practice Address - Phone:605-328-2663
Practice Address - Fax:605-328-3760
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10047207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine