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General NPI Number Information
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NPI Number | 1770236051
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Entity Type | Organization
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Legal Business Name | HER DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 316 HALTON CROSSING DR SW
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City | CONCORD
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State | NC
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Zip | 28027-9432
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Country | US
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Telephone | 704-794-3178
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Fax |
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Provider Business Mailing Address
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Address Line | 316 HALTON CROSSING DR SW
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City | CONCORD
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State | NC
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Zip | 28027-9432
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Country | US
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Telephone | 704-794-3178
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | TANNEKU GARDNER
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Credential |
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Telephone | 704-794-3178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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