Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D9287 | MN |
NPI | 1265584213 |
---|---|
Provider Name | Dr. Christine L Hermanson |
First Address | Maplewood, MN 55109 |
Second Address | Maplewood, MN 55109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |