MEDICARE: KATHRYN M HERRERA

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
1	163WL0100X	Lactation Consultant (Registered Nurse)	041374305	IL

General Provider Information

NPI Number	:	1952889420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN M HERRERA

Provider Business Mailing Address
First Line	:	861 BRISTOL DR
Second Line	:
City	:	ALGONQUIN
State	:	IL
Zip	:	60102-4328
Country	:	US
Telephone Number	:	847-677-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 N RANDALL RD STE 309
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-2304
Country	:	US
Telephone Number	:	847-741-7990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	12/14/2018

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