Healthcare Provider Details

I. General information

NPI: 1023053287
Provider Name (Legal Business Name): MARIANNE HERMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE
EGG HARBOR TOWNSHIP NJ
08234-5549
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE
EGG HARBOR TOWNSHIP NJ
08234-5549
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-7731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN09505500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: