Provider Demographics
NPI:1932462074
Name:HERMAN, RAECHEL DARLENE (LMP)
Entity Type:Individual
Prefix:
First Name:RAECHEL
Middle Name:DARLENE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12351 PINTAIL LN NW
Mailing Address - Street 2:APT. 201
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7627
Mailing Address - Country:US
Mailing Address - Phone:360-516-8698
Mailing Address - Fax:
Practice Address - Street 1:3561 NW ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9130
Practice Address - Country:US
Practice Address - Phone:360-692-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60251064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist