Healthcare Provider Details

I. General information

NPI: 1912148586
Provider Name (Legal Business Name): CHRISTINE ANNE HERR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BRADBURY DR SE
ALBUQUERQUE NM
87106-4374
US

IV. Provider business mailing address

2222 UPTOWN LOOP NE APT 2203
ALBUQUERQUE NM
87110-6029
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax:
Mailing address:
  • Phone: 505-506-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2012-0457
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: