Provider Demographics
NPI:1700564762
Name:HERRERA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HERRERA
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 1:314 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:BELFIELD
Mailing Address - State:ND
Mailing Address - Zip Code:58622-7507
Mailing Address - Country:US
Mailing Address - Phone:701-495-3472
Mailing Address - Fax:
Practice Address - Street 1:314 3RD ST NW
Practice Address - Street 2:
Practice Address - City:BELFIELD
Practice Address - State:ND
Practice Address - Zip Code:58622-7507
Practice Address - Country:US
Practice Address - Phone:701-495-3472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care