Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201500 | NC |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201500 | NC |
NPI | 1023189255 |
---|---|
Provider Name | Ms. Alida Suzanne Herrera |
First Address | Sylva, NC 28779-2187 |
Second Address | Sylva, NC 28779-8511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201500 | MEDICAL LICENSE (01) | NC |
6113070 | (05) | NC |