Provider Demographics
NPI:1003823204
Name:HERMAN, CAROL M (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:HERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1724
Mailing Address - Country:US
Mailing Address - Phone:308-632-2540
Mailing Address - Fax:308-633-2650
Practice Address - Street 1:975 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1712
Practice Address - Country:US
Practice Address - Phone:308-632-2540
Practice Address - Fax:308-633-2650
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE581OtherSTATE LICENSE