Provider Demographics
NPI:1710370549
Name:HERMANN, CARLA SUE (TECHNICIAN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:HERMANN
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 TECH DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3262
Mailing Address - Country:US
Mailing Address - Phone:563-355-1611
Mailing Address - Fax:563-355-6617
Practice Address - Street 1:2485 TECH DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3262
Practice Address - Country:US
Practice Address - Phone:563-355-1611
Practice Address - Fax:563-355-6617
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA330101051150255183700000X
374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No183700000XPharmacy Service ProvidersPharmacy Technician