Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7491 | MN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 7491 | MN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 7491 | MN |
NPI | 1043821622 |
---|---|
Provider Name | Dr. Byron Howard Herdman |
First Address | Henning, MN 56551-9521 |
Second Address | Henning, MN 56551-9521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2020 |
Last Update Date | 16/08/2020 |