Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1790118289 |
---|---|
Provider Name | Mark A Herndon |
First Address | Fletcher, NC 28732-8241 |
Second Address | Fletcher, NC 28732-8241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2013 |
Last Update Date | 20/08/2013 |