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General NPI Number Information
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NPI Number | 1588286520
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Entity Type | Individual
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Provider Name | ANTONIO W HEROLD CRNP-PMH
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Gender | Male
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 501 S UNION AVE
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3409
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Country | US
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Telephone | 443-843-8054
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Fax |
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Provider Business Mailing Address
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Address Line | 596 SHADY BRK
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City | GLEN BURNIE
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State | MD
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Zip | 21060-8620
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Country | US
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Telephone | 410-303-9070
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R203258
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License Number State | MD
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