Provider Demographics
NPI:1336241850
Name:HERMAN, CHARLENE MARY (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARY
Last Name:HERMAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1646
Mailing Address - Country:US
Mailing Address - Phone:419-872-4657
Mailing Address - Fax:
Practice Address - Street 1:3805 RUSHLAND AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4313
Practice Address - Country:US
Practice Address - Phone:419-471-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 208172163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2311475OtherRN INDEPENDENT PROVIDER