Healthcare Provider Details

I. General information

NPI: 1417612896
Provider Name (Legal Business Name): HERARDINE LOUIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 03/17/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST SEMC - CARDIAC SURGERY -
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

240 HEATH ST APT 304
JAMAICA PLAIN MA
02130-1142
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2045
  • Fax:
Mailing address:
  • Phone: 857-445-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2277045
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2277045
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: