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NPI Code Detail

MEDICARE: SANDRA HERRERA LPN

MEDICARE: SANDRA HERRERA LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse44319GA

General Provider Information

NPI Number : 1699065789
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA HERRERA LPN
Provider Business Mailing Address
First Line : 3441 CYPRESS MILL RD
Second Line : SUITE 102
City : BRUNSWICK
State : GA
Zip : 31520-2878
Country : US
Telephone Number : 912-554-8542
Fax Number : 912-264-5965
Provider Business Practice Location Address
First Line : 1113 E OGLETHORPE HWY
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-1200
Country : US
Telephone Number : 912-368-3502
Fax Number : 912-368-6844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2011
Last Update Date : 04/11/2011

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