Healthcare Provider Details

I. General information

NPI: 1336241850
Provider Name (Legal Business Name): CHARLENE MARY HERMAN R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 RUSHLAND AVE
TOLEDO OH
43613-4313
US

IV. Provider business mailing address

1085 EASTBROOK DR
PERRYSBURG OH
43551-1646
US

V. Phone/Fax

Practice location:
  • Phone: 419-471-0124
  • Fax:
Mailing address:
  • Phone: 419-872-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 208172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: