Provider Demographics
NPI:1124058300
Name:HERRMANN, JEANNE M (PA-C)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2551
Mailing Address - Country:US
Mailing Address - Phone:603-224-3368
Mailing Address - Fax:603-724-2581
Practice Address - Street 1:264 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2551
Practice Address - Country:US
Practice Address - Phone:603-224-3368
Practice Address - Fax:603-724-2581
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30331166Medicaid
NH30331166Medicaid
NHAP1412Medicare PIN