Provider Demographics
NPI:1952754293
Name:HERRELSON, WHITNEY ALAIN (LM)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ALAIN
Last Name:HERRELSON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ELEU PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8236
Mailing Address - Country:US
Mailing Address - Phone:808-298-1841
Mailing Address - Fax:808-207-0028
Practice Address - Street 1:147 ELEU PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8236
Practice Address - Country:US
Practice Address - Phone:808-298-1841
Practice Address - Fax:808-207-0028
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 174N00000X, 374J00000X
HIMW-28176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1952754293Medicaid