Healthcare Provider Details

I. General information

NPI: 1811602386
Provider Name (Legal Business Name): SARAH NICOLE HERRON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E COURTLAND ST
MORTON IL
61550-9054
US

IV. Provider business mailing address

772 PIERCE ST
MORTON IL
61550-1758
US

V. Phone/Fax

Practice location:
  • Phone: 309-291-0899
  • Fax:
Mailing address:
  • Phone: 309-634-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01230853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: