Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1300X | Electrophysiology, Clinical | 070-010918 | IL |
NPI | 1639175979 |
---|---|
Provider Name | Deana Herrman |
First Address | Oak Park, IL 60302-1248 |
Second Address | Oak Park, IL 60302-1248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 25/09/2010 |