Healthcare Provider Details

I. General information

NPI: 1720141294
Provider Name (Legal Business Name): ANDREA LEA HERINGTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 506
SAN FRANCISCO CA
94110-4418
US

IV. Provider business mailing address

530 VALLEY FORGE WAY
CAMPBELL CA
95008-0546
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-6996
  • Fax: 415-641-6831
Mailing address:
  • Phone: 408-718-3693
  • Fax: 415-641-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: