Provider Demographics
NPI:1942946611
Name:HERBERT, MATTHEW (LPN, AEMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HERBERT
Suffix:
Gender:M
Credentials:LPN, AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 PLAINFIELD RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-2001
Mailing Address - Country:US
Mailing Address - Phone:603-298-2146
Mailing Address - Fax:
Practice Address - Street 1:254 PLAINFIELD RD UNIT 4
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2001
Practice Address - Country:US
Practice Address - Phone:603-298-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH011173-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse