Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 9338 | WI |
N | 363LN0000X | Nurse Practitioner - Neonatal | 1007513 | TX |
NPI | 1225528318 |
---|---|
Provider Name | Crista Herebia |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Elkhorn, WI 53121-4337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 23/11/2021 |