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General NPI Number Information
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NPI Number | 1992894042
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Entity Type | Individual
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Provider Name | ILSE M. HERRERA NP, MSN
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 500 WEST FORT STREET
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City | BOISE
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State | ID
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Zip | 83702-4598
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Country | US
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Telephone | 208-422-1325
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Fax | 208-422-1408
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Provider Business Mailing Address
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Address Line | 500 W. FORT ST. # 111
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-422-1000
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Fax | 208-422-1319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | N27129
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | N27129
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | N27129
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License Number State | ID
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