Provider Demographics
NPI:1083939763
Name:HEROLD, KARIN LYNN (RN)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:LYNN
Last Name:HEROLD
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 1:19021 FREEPORT ST NW STE 400
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1281
Mailing Address - Country:US
Mailing Address - Phone:763-633-3800
Mailing Address - Fax:
Practice Address - Street 1:415 N 1ST ST APT 600
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-4316
Practice Address - Country:US
Practice Address - Phone:763-633-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR189826-6163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health