Healthcare Provider Details

I. General information

NPI: 1164202164
Provider Name (Legal Business Name): EVELYN HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 DAUPHIN ST
MOBILE AL
36608-1780
US

IV. Provider business mailing address

13700 LACO COOPER RD
WILMER AL
36587-8206
US

V. Phone/Fax

Practice location:
  • Phone: 251-380-4000
  • Fax:
Mailing address:
  • Phone: 251-423-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: