Provider Demographics
NPI:1578629671
Name:HERRING, EVA YOLANDA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:YOLANDA
Last Name:HERRING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3621
Mailing Address - Country:US
Mailing Address - Phone:734-282-0809
Mailing Address - Fax:
Practice Address - Street 1:5500 FORT ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4602
Practice Address - Country:US
Practice Address - Phone:734-671-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001373A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist