Provider Demographics
NPI:1104553932
Name:HERBERT, PASSION ENADE
Entity type:Individual
Prefix:
First Name:PASSION
Middle Name:ENADE
Last Name:HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 MAIN ST STE 102&103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-5509
Mailing Address - Country:US
Mailing Address - Phone:405-609-6595
Mailing Address - Fax:
Practice Address - Street 1:5505 MAIN ST STE 102&103
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5509
Practice Address - Country:US
Practice Address - Phone:405-609-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator