Provider Demographics
NPI:1205208048
Name:HERRERA, KATHLEEN HELEN (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HELEN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BADGER RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3201
Mailing Address - Country:US
Mailing Address - Phone:631-909-4379
Mailing Address - Fax:631-909-4379
Practice Address - Street 1:27 BADGER RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3201
Practice Address - Country:US
Practice Address - Phone:631-909-4379
Practice Address - Fax:631-909-4379
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577916-1146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant