Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53104 | MN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 01077087A | IN |
NPI | 1043441231 |
---|---|
Provider Name | Angela C Herman |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201374370 | (05) | IN |