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General NPI Number Information
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NPI Number | 1306071345
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Entity Type | Individual
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Provider Name | BETH MARIE SHERMAN IDMT
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 36 MDOS/SGOAF UNIT 14010
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City | APO
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State | AP
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Zip | 96543-4010
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Country | US
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Telephone | 315-366-3231
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Fax |
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Provider Business Mailing Address
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Address Line | 124 D ST SUITE D
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City | TAMUNING
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State | GU
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Zip | 96913-3744
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Country | US
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Telephone | 671-988-5615
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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