Individual
MRS. JENNIFER L HERDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
101 HEART DR, GREENVILLE, NC 27834-8982
(252) 744-4611
(252) 816-0762
Mailing address
1005 LEXINGTON DOWNS DR, GREENVILLE, NC 27858-7203
(252) 414-8271
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01611
NC
363A00000X
Physician Assistant
0110001773
VA
363AM0700X
Medical Physician Assistant
0010-01611
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S96783
—
VA
Enumeration date
06/15/2006
Last updated
04/05/2024
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