Provider Demographics
NPI:1275117228
Name:HERMILLER, JENNIFER LYNN (CNM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:HERMILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0204
Mailing Address - Country:US
Mailing Address - Phone:419-722-2455
Mailing Address - Fax:
Practice Address - Street 1:1220 E ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2803
Practice Address - Country:US
Practice Address - Phone:419-998-8245
Practice Address - Fax:419-998-8247
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.0019479367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife