Healthcare Provider Details

I. General information

NPI: 1306663984
Provider Name (Legal Business Name): GIMI RAYE HERREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 175
CHICO CA
95926-2460
US

IV. Provider business mailing address

3211 COHASSET RD STE 130
CHICO CA
95973-5403
US

V. Phone/Fax

Practice location:
  • Phone: 530-879-3950
  • Fax:
Mailing address:
  • Phone: 530-879-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number628150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: