Healthcare Provider Details

I. General information

NPI: 1891771069
Provider Name (Legal Business Name): LYNN M HERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STRAIGHT ST MILLENIUM ANESTHESIA LLC
CINCINNATI OH
45219
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DRIVE SUITE 258
EDGEWOOD KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number160686
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: