=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053664102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA HERNDON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2012
-----------------------------------------------------
Last Update Date | 10/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33150 SCHOOLCRAFT RD SUITE 203
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-581-6674
-----------------------------------------------------
Fax | 734-943-6023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33150 SCHOOLCRAFT RD SUITE 203
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-581-6674
-----------------------------------------------------
Fax | 734-943-6023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 46-0748116
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------