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Individual

LAURIE HERNDON

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
GNP

Contact information

Practice address
630 PLANTATION ST, WORCESTER, MA 01605
(508) 595-2000
(508) 853-7149
Mailing address
630 PLANTATION ST, WOT 12TH FLOOR ATTN PHYSICIAN SERVICES, WORCESTER, MA 01605
(508) 368-5529
(508) 368-5530

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
187387
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04247226
ONE HEALTH PLAN
01
042472266008
TRICARE CHAMPUS
01
0700711
WELFARE
05
0700711
MA
01
57676
FALLON COMMUNITY HEALTH P
01
8300302
EVERCARE
01
AA3450
HARVARD PILGRIL HEALTHCAR
01
NP0660
BLUE SHIELD INDEMNITY
Enumeration date
02/14/2006
Last updated
07/08/2007
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