Individual
KIM JENNIFER HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1001 N BROADWAY, SUITE A-3, EVERETT, WA 98201-1586
(425) 317-0300
(425) 317-0303
Mailing address
909 N BROADWAY, PBO, EVERETT, WA 98201-1409
(425) 317-0699
(425) 317-0291
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004579
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8384745
—
WA
Enumeration date
10/05/2006
Last updated
02/24/2009
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