Provider Demographics
NPI:1780773523
Name:HEBERT, CHRISTOPHER WAYNE (IDMT, HS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:HEBERT
Suffix:
Gender:M
Credentials:IDMT, HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2424
Mailing Address - Country:US
Mailing Address - Phone:218-529-3131
Mailing Address - Fax:218-529-3135
Practice Address - Street 1:1201 MINNESOTA AVE
Practice Address - Street 2:USCGC ALDER (WLB-216)
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2492
Practice Address - Country:US
Practice Address - Phone:218-529-3131
Practice Address - Fax:218-529-3135
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other