Provider Demographics
NPI:1003051483
Name:HERRING, THERESA ANNETTE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNETTE
Last Name:HERRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 CENTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4411 CENTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2435
Practice Address - Country:US
Practice Address - Phone:402-558-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE676133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered