Healthcare Provider Details

I. General information

NPI: 1679784185
Provider Name (Legal Business Name): LOU ANN TABOR HERFERT RNC, CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

2876 WAKEFIELD DR
BELMONT CA
94002-2935
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8800
  • Fax: 650-497-8034
Mailing address:
  • Phone: 650-497-8800
  • Fax: 650-497-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number8984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: