Healthcare Provider Details

I. General information

NPI: 1679421036
Provider Name (Legal Business Name): WILMA MARINE HERNDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N ALSTON AVE
DURHAM NC
27701-4054
US

IV. Provider business mailing address

700 CECIL ST
DURHAM NC
27707-3255
US

V. Phone/Fax

Practice location:
  • Phone: 919-560-3910
  • Fax:
Mailing address:
  • Phone: 919-530-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: