Provider Demographics
NPI:1871366468
Name:TANDIA, HERMINA KWANGSA (DNP)
Entity type:Individual
Prefix:
First Name:HERMINA
Middle Name:KWANGSA
Last Name:TANDIA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6734
Mailing Address - Country:US
Mailing Address - Phone:641-980-5031
Mailing Address - Fax:
Practice Address - Street 1:1932 SW 3RD ST STE 4
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2400
Practice Address - Country:US
Practice Address - Phone:641-980-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2023127704363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health