Provider Demographics
NPI:1932663648
Name:HERMANN, MARIA ROSE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSE
Last Name:HERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 STATE ROUTE Y
Mailing Address - Street 2:
Mailing Address - City:BLOOMSDALE
Mailing Address - State:MO
Mailing Address - Zip Code:63627-9068
Mailing Address - Country:US
Mailing Address - Phone:573-535-1446
Mailing Address - Fax:
Practice Address - Street 1:11671 STATE ROUTE Y
Practice Address - Street 2:
Practice Address - City:BLOOMSDALE
Practice Address - State:MO
Practice Address - Zip Code:63627-9068
Practice Address - Country:US
Practice Address - Phone:573-535-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program