Provider Demographics
NPI:1447587241
Name:HERNDON, ANTHONY JAMELLE
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMELLE
Last Name:HERNDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 IRVING BLVD NW
Mailing Address - Street 2:APT. 1407
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3903
Mailing Address - Country:US
Mailing Address - Phone:646-248-4750
Mailing Address - Fax:
Practice Address - Street 1:4701 IRVING BLVD NW
Practice Address - Street 2:APT. 1407
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3903
Practice Address - Country:US
Practice Address - Phone:646-248-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide