Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R161673 | MD |
N | 363LA2200X | Nurse Practitioner - Adult Health | CNP01391 | NM |
Y | 363LG0600X | Nurse Practitioner - Gerontology | CNP01391 | NM |
NPI | 1013968148 |
---|---|
Provider Name | Patricia Herson |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87106-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 10/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
407573100 | (05) | MD |
Q45681 | (02) | MD |