Provider Demographics
NPI:1255194924
Name:HERMAN, LAURA (DAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2134
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1134
Mailing Address - Country:US
Mailing Address - Phone:814-777-3171
Mailing Address - Fax:
Practice Address - Street 1:7130 MINSTREL WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5201
Practice Address - Country:US
Practice Address - Phone:814-777-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty