Provider Demographics
NPI:1184604860
Name:HERROLD, SUSAN (FNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:HERROLD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 BAKER CT
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3336
Mailing Address - Country:US
Mailing Address - Phone:360-240-1883
Mailing Address - Fax:
Practice Address - Street 1:3475 N SARATOGA ST
Practice Address - Street 2:COMMAND SUITE
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-4927
Practice Address - Country:US
Practice Address - Phone:360-257-9974
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN094915163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care