Healthcare Provider Details

I. General information

NPI: 1710622907
Provider Name (Legal Business Name): MRS. MYNHIA HER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYNHIA VANG

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22471 GRATIOT AVE
EASTPOINTE MI
48021-2353
US

IV. Provider business mailing address

22471 GRATIOT AVE
EASTPOINTE MI
48021-2353
US

V. Phone/Fax

Practice location:
  • Phone: 586-218-7774
  • Fax:
Mailing address:
  • Phone: 586-218-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704302545
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: