Provider Demographics
NPI:1861017501
Name:HER, JUDY (LVN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 D ST STE G
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5957
Mailing Address - Country:US
Mailing Address - Phone:530-742-7747
Mailing Address - Fax:530-742-7746
Practice Address - Street 1:201 D ST STE G
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5957
Practice Address - Country:US
Practice Address - Phone:530-742-7747
Practice Address - Fax:530-742-7746
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707828164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse