1821812116 NPI number — MICHELLE MARY HERNDON MLT, (ASCP)CM

Table of content: MICHELLE MARY HERNDON MLT, (ASCP)CM (NPI 1821812116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821812116 NPI number — MICHELLE MARY HERNDON MLT, (ASCP)CM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNDON
Provider First Name:
MICHELLE
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MLT, (ASCP)CM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDERMOTT
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821812116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
566 GREENBRIAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08094-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-524-2323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
566 GREENBRIAR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08094-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-524-2323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246QM0706X , with the licence number:  66944 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3401146 . This is a "CDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 66944 . This is a "ASCP" identifier . This identifiers is of the category "OTHER".