Provider Demographics
NPI:1023189255
Name:HERRERA, ALIDA SUZANNE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ALIDA
Middle Name:SUZANNE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2187
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2187
Mailing Address - Country:US
Mailing Address - Phone:828-631-3973
Mailing Address - Fax:828-631-9280
Practice Address - Street 1:44 BONNIE LN
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8511
Practice Address - Country:US
Practice Address - Phone:828-631-3973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201500363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201500OtherMEDICAL LICENSE
NC6113070Medicaid
NC201500OtherMEDICAL LICENSE