Provider Demographics
NPI:1750957395
Name:HER, NANCY Y (ORT/L)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:Y
Last Name:HER
Suffix:
Gender:F
Credentials:ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 GREENE AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5855
Mailing Address - Country:US
Mailing Address - Phone:612-385-5659
Mailing Address - Fax:
Practice Address - Street 1:1133 GREENE AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5855
Practice Address - Country:US
Practice Address - Phone:612-385-5659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104579OtherMN STATE OCCUPATIONAL THERAPY