Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 237438 | MA |
Y | 2084N0400X | Neurologist | 58742 | AZ |
N | 2084N0600X | Clinical Neurophysiologist | 237438 | MA |
NPI | 1255365920 |
---|---|
Provider Name | Susan T Herman |
First Address | Phoenix, AZ 85013-4407 |
Second Address | Phoenix, AZ 85013-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 29/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018832530001 | (05) | PA |
G93223 | (02) |