Provider Demographics
NPI:1457018749
Name:HERALD, BIRDINE MILDRED-MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:BIRDINE
Middle Name:MILDRED-MARIE
Last Name:HERALD
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 1:1941 CHARLEY BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951-7360
Mailing Address - Country:US
Mailing Address - Phone:304-994-1262
Mailing Address - Fax:
Practice Address - Street 1:2100 ROANOKE ST STE 1
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2512
Practice Address - Country:US
Practice Address - Phone:434-941-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002061023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002061023OtherLPN