Provider Demographics
NPI:1568962496
Name:HERRIN, MINDY L (CRNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:HERRIN
Suffix:
Gender:F
Credentials:CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 PROSPECT HILL LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-2246
Mailing Address - Country:US
Mailing Address - Phone:217-799-1574
Mailing Address - Fax:
Practice Address - Street 1:4110 PROSPECT HILL LN
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-2246
Practice Address - Country:US
Practice Address - Phone:217-799-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily