Healthcare Provider Details

I. General information

NPI: 1982195947
Provider Name (Legal Business Name): TRINA A HERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VIRGINIA AVENUE
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

1923 DEVONSHIRE DR
COLUMBIA MO
65203-7006
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-7497
  • Fax: 573-882-5847
Mailing address:
  • Phone: 573-268-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number18-0414
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: