Provider Demographics
NPI:1740086495
Name:HERDMAN, MARTHA M
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:HERDMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2623
Mailing Address - Country:US
Mailing Address - Phone:304-542-4511
Mailing Address - Fax:
Practice Address - Street 1:808 PARK DR
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2623
Practice Address - Country:US
Practice Address - Phone:304-542-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant