Provider Demographics
NPI:1235885419
Name:HERRICK, COLBY
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:HERRICK
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 1:70 WINNEPOCKET RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NH
Mailing Address - Zip Code:03303-7510
Mailing Address - Country:US
Mailing Address - Phone:603-340-1412
Mailing Address - Fax:
Practice Address - Street 1:70 WINNEPOCKET RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NH
Practice Address - Zip Code:03303-7510
Practice Address - Country:US
Practice Address - Phone:603-340-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHTBD363L00000X
NH075718-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse