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General NPI Number Information
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NPI Number | 1184604860
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Entity Type | Individual
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Provider Name | SUSAN HERROLD FNP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3475 N SARATOGA ST COMMAND SUITE
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City | OAK HARBOR
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State | WA
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Zip | 98278-4927
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Country | US
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Telephone | 360-257-9974
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 BAKER CT
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City | OAK HARBOR
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State | WA
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Zip | 98277-3336
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Country | US
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Telephone | 360-240-1883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | RN094915
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License Number State | GA
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