Healthcare Provider Details

I. General information

NPI: 1861761835
Provider Name (Legal Business Name): STEPHANIE H HERRERA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE H HERRERA CRNA

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CITYWEST BLVD STE. 300
HOUSTON TX
77042
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 713-620-4000
  • Fax: 713-458-4229
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP131435
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2276384
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25589
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: