Provider Demographics
NPI:1326149329
Name:HERRICK, AMY ELISABETH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELISABETH
Last Name:HERRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2451
Mailing Address - Country:US
Mailing Address - Phone:925-997-5180
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4366
Practice Address - Fax:510-535-7531
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered