Healthcare Provider Details

I. General information

NPI: 1730206798
Provider Name (Legal Business Name): LARRY JOSEPH HERDENER ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NE EVANS ST
MCMINNVILLE OR
97128-4605
US

IV. Provider business mailing address

340 NE EVANS ST
MCMINNVILLE OR
97128-4605
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-6170
  • Fax: 503-472-2711
Mailing address:
  • Phone: 503-434-6170
  • Fax: 503-472-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number579
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: