Provider Demographics
NPI:1457613804
Name:HERRERA, YESSY IVETH (RN)
Entity Type:Individual
Prefix:MISS
First Name:YESSY
Middle Name:IVETH
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SAINT ANNS AVE
Mailing Address - Street 2:#12C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4727
Mailing Address - Country:US
Mailing Address - Phone:917-645-5248
Mailing Address - Fax:
Practice Address - Street 1:164 SAINT ANNS AVE
Practice Address - Street 2:#12C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4727
Practice Address - Country:US
Practice Address - Phone:917-645-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642192-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse