Healthcare Provider Details

I. General information

NPI: 1144641085
Provider Name (Legal Business Name): JESSIE LENAE HERRERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1243
US

IV. Provider business mailing address

5250 HOLMAN RD
LAS CRUCES NM
88012-7018
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5884
  • Fax: 575-527-5886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-74841
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: