MEDICARE: MRS. PAULETTE H. HERMAN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R35306	NM

General Provider Information

NPI Number	:	1609875210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULETTE H. HERMAN CNP

Provider Business Mailing Address
First Line	:	288 DANDELION LN
Second Line	:
City	:	CORRALES
State	:	NM
Zip	:	87048-7819
Country	:	US
Telephone Number	:	505-462-8855
Fax Number	:	505-462-8461

Provider Business Practice Location Address
First Line	:	4005 HIGH RESORT BLVD SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-5906
Country	:	US
Telephone Number	:	505-464-8855
Fax Number	:	505-462-8461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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