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General NPI Number Information
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NPI Number | 1710370549
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Entity Type | Individual
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Provider Name | CARLA SUE HERMANN TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 2485 TECH DR
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City | BETTENDORF
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State | IA
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Zip | 52722-3262
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Country | US
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Telephone | 563-355-1611
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Fax | 563-355-6617
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Provider Business Mailing Address
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Address Line | 2485 TECH DR
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City | BETTENDORF
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State | IA
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Zip | 52722-3262
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Country | US
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Telephone | 563-355-1611
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Fax | 563-355-6617
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 330101051150255
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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