Provider Demographics
NPI:1548903735
Name:HER, PA NHIA
Entity type:Individual
Prefix:
First Name:PA NHIA
Middle Name:
Last Name:HER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 189TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8320
Mailing Address - Country:US
Mailing Address - Phone:651-285-5652
Mailing Address - Fax:
Practice Address - Street 1:5700 BOTTINEAU BLVD STE 270
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2671
Practice Address - Country:US
Practice Address - Phone:763-200-8952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14725122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program