Provider Demographics
NPI:1477611283
Name:HERRON, ANDREA NITA (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NITA
Last Name:HERRON
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:NITA
Other - Last Name:GOOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1230 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3326
Mailing Address - Country:US
Mailing Address - Phone:805-543-6988
Mailing Address - Fax:805-543-6692
Practice Address - Street 1:1230 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3326
Practice Address - Country:US
Practice Address - Phone:805-543-6988
Practice Address - Fax:805-543-6692
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL190788163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME 02129FMedicaid
CANP0028100Medicaid