Provider Demographics
NPI:1821394198
Name:HERMAN, AUDREY IRENE (RDH)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:IRENE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:RDH
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 152
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-0152
Mailing Address - Country:US
Mailing Address - Phone:360-244-5850
Mailing Address - Fax:
Practice Address - Street 1:2006 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-0152
Practice Address - Country:US
Practice Address - Phone:360-244-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60172854124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist