Healthcare Provider Details

I. General information

NPI: 1851457782
Provider Name (Legal Business Name): PATRICIA JOSEPHINE HERRON APRN, BC, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NW 5TH ST
BRAINERD MN
56401-2902
US

IV. Provider business mailing address

13205 57TH AVE SW
MOTLEY MN
56466-2163
US

V. Phone/Fax

Practice location:
  • Phone: 218-829-3235
  • Fax: 218-829-1368
Mailing address:
  • Phone: 218-746-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR106085-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: