Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 209018761 | IL |
NPI | 1184189359 |
---|---|
Provider Name | Melissa K Herrin |
First Address | Urbana, IL 61801-2529 |
Second Address | Urbana, IL 61801-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2019 |
Last Update Date | 01/02/2019 |