Provider Demographics
NPI:1578927695
Name:WARD-HERSEE, BRIANNE ERIN
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:ERIN
Last Name:WARD-HERSEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10804 MARBLE STONE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2024
Mailing Address - Country:US
Mailing Address - Phone:505-415-2423
Mailing Address - Fax:
Practice Address - Street 1:10804 MARBLE STONE DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-2024
Practice Address - Country:US
Practice Address - Phone:505-415-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM506826004247200000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other