Individual
MRS. MELISSA HEERMANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
71 PROSPECT AVE, HUDSON, NY 12534-2907
(518) 828-8500
Mailing address
71 PROSPECT AVE, HUDSON, NY 12534-2907
(518) 828-8500
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
AP1755
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101755
CONNECTICARE NUMBER
—
05
—
1310097
—
MA
01
—
83-02707
EVERCARE #
MA
01
—
AP1755
LICENSE
MA
01
—
MC0540093J
CSR #
MA
Enumeration date
04/17/2006
Last updated
03/07/2023
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