Provider Demographics
NPI:1326474040
Name:HERRIMAN, MARY EVA (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EVA
Last Name:HERRIMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S GARAND ST
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-7080
Mailing Address - Country:US
Mailing Address - Phone:207-660-5130
Mailing Address - Fax:
Practice Address - Street 1:11 EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-3309
Practice Address - Country:US
Practice Address - Phone:207-238-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELPN12389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse