Provider Demographics
NPI:1023596467
Name:HERB, KAREN L (MS CNS LDN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:HERB
Suffix:
Gender:F
Credentials:MS CNS LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20689-9507
Mailing Address - Country:US
Mailing Address - Phone:443-618-4931
Mailing Address - Fax:
Practice Address - Street 1:5621 VICTORIA LN
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MD
Practice Address - Zip Code:20689-9507
Practice Address - Country:US
Practice Address - Phone:443-618-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDZ4368133N00000X
MDDX4368133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist