Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 5399 | AZ |
NPI | 1043651540 |
---|---|
Provider Name | Rachel Sara Herrin |
First Address | Surprise, AZ 85378 |
Second Address | Surprise, AZ 85378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2013 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
840234 | (05) | AZ |