Provider Demographics
NPI:1891774931
Name:HERRERA, ELIZABETH V (APNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:HERRERA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848298
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8298
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-537-6869
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 311
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-537-6000
Practice Address - Fax:254-537-6001
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI691-033363L00000X
TXAP118044367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43851200Medicaid
WIK400094853Medicare PIN
WIS59925Medicare UPIN
WI43851200Medicaid