Healthcare Provider Details

I. General information

NPI: 1184997058
Provider Name (Legal Business Name): SUSAN HERNDON LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21402 MEADOWHILL DR
SPRING TX
77388-3345
US

IV. Provider business mailing address

21402 MEADOWHILL DR
SPRING TX
77388-3345
US

V. Phone/Fax

Practice location:
  • Phone: 281-642-3808
  • Fax: 281-528-7587
Mailing address:
  • Phone: 281-642-3808
  • Fax: 281-954-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: