Provider Demographics
NPI:1043447469
Name:HERMAN, MATTHEW T (RN BSN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:HERMAN
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 W OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3618
Mailing Address - Country:US
Mailing Address - Phone:602-707-2615
Mailing Address - Fax:602-707-2640
Practice Address - Street 1:1226 W OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3618
Practice Address - Country:US
Practice Address - Phone:602-707-2615
Practice Address - Fax:602-707-2640
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN086627163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool