Provider Demographics
NPI:1457300527
Name:HERDER, PAMELA RAE (RNC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:HERDER
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 CHICAGO AVE S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1320
Mailing Address - Country:US
Mailing Address - Phone:612-863-5390
Mailing Address - Fax:612-863-2697
Practice Address - Street 1:2800 CHICAGO AVE S
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1320
Practice Address - Country:US
Practice Address - Phone:612-863-5390
Practice Address - Fax:612-863-2697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0704278OtherMEDICA
MNHP50671OtherHEALTH PARTNERS
MN2327569OtherAMERICAS PRO
MN333481043304OtherPREFERRED ONE
MN64641CEOtherBLUE CROSS