Individual
MARY G HERMANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2 3RD AVE SW, TOWNER, ND 58788-0156
(701) 537-2007
(701) 537-5407
Mailing address
1312 HIGHWAY 49 N, BEULAH, ND 58523-6038
(701) 873-7788
(701) 873-4485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0038
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4693
BLUE SHIELD
ND
05
—
5913
—
ND
Enumeration date
09/24/2006
Last updated
04/01/2009
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