Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60957049 | WA |
NPI | 1003460064 |
---|---|
Provider Name | Oscar Herrera |
First Address | Puyallup, WA 98372-3797 |
Second Address | Puyallup, WA 98372-3797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 22/09/2019 |