Provider Demographics
NPI:1083681829
Name:HERRON, VICKI RENEE' (LPN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:RENEE'
Last Name:HERRON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E CHEYENNE MOUNTAIN BLVD
Mailing Address - Street 2:#23
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8516
Mailing Address - Country:US
Mailing Address - Phone:719-540-0429
Mailing Address - Fax:
Practice Address - Street 1:440 E CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:#23
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8516
Practice Address - Country:US
Practice Address - Phone:719-540-0429
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38857164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse