Provider Demographics
NPI:1073934717
Name:HERD, SUNDAE (RN)
Entity Type:Individual
Prefix:
First Name:SUNDAE
Middle Name:
Last Name:HERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NW BROOK LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-5096
Mailing Address - Country:US
Mailing Address - Phone:386-365-3637
Mailing Address - Fax:
Practice Address - Street 1:305 NW BROOK LOOP
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-5096
Practice Address - Country:US
Practice Address - Phone:386-365-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3174212163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse