Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 38148 | KY |
Y | 2080P0204X | Pediatric Emergency Doctor | 38148 | KY |
NPI | 1306821467 |
---|---|
Provider Name | Sandra M Herr |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200460960 | (05) | IN |
64073380 | (05) | KY |
H40509 | (02) |