Healthcare Provider Details

I. General information

NPI: 1992772107
Provider Name (Legal Business Name): RACHEL ELLEN RIDENOUR HERMAN MS RN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 CARMEN AVE
INVER GROVE HEIGHTS MN
55076-4416
US

IV. Provider business mailing address

618 19TH AVE SW
ROCHESTER MN
55902-0961
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-9697
  • Fax: 651-455-2012
Mailing address:
  • Phone: 507-281-4509
  • Fax: 507-281-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberMN R 1297074
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: