Provider Demographics
NPI:1679364152
Name:HER, ELDINA
Entity type:Individual
Prefix:
First Name:ELDINA
Middle Name:
Last Name:HER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELDINA
Other - Middle Name:
Other - Last Name:AHMETOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11811 ZEA ST NW APT 302
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-6817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5800 SAINT CROIX AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4446
Practice Address - Country:US
Practice Address - Phone:612-246-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202820224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant