1447471552 NPI number — HERMEN HEALTH, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447471552 NPI number — HERMEN HEALTH, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERMEN HEALTH, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447471552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 NICOLLET MALL
Provider Second Line Business Mailing Address:
SUITE 805
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55402-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-339-0149
Provider Business Mailing Address Fax Number:
612-332-5972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 NICOLLET MALL
Provider Second Line Business Practice Location Address:
SUITE 805
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55402-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-339-0149
Provider Business Practice Location Address Fax Number:
612-332-5972
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERMEN
Authorized Official First Name:
JILL
Authorized Official Middle Name:
SUNWHA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-339-0149

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4597 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1912998055 . This is a "NPI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 965001043709 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 396G9HE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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