Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 908296 | TX |
NPI | 1003477019 |
---|---|
Provider Name | Samantha Marie Herman |
First Address | Kingwood, TX 77339-6009 |
Second Address | Kingwood, TX 77339-6009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2019 |
Last Update Date | 03/06/2020 |