Healthcare Provider Details

I. General information

NPI: 1174251813
Provider Name (Legal Business Name): ARMANDA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 4TH ST NW
ALBUQUERQUE NM
87107-2510
US

IV. Provider business mailing address

1431 GIRARD BLVD NE APT 24
ALBUQUERQUE NM
87106-1851
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-4493
  • Fax:
Mailing address:
  • Phone: 505-503-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: