Provider Demographics
NPI:1104687342
Name:HERRERA, RONALD A (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:HERRERA
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CONSTITUTION RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2197
Mailing Address - Country:US
Mailing Address - Phone:719-562-9200
Mailing Address - Fax:719-584-2353
Practice Address - Street 1:1601 CONSTITUTION RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2197
Practice Address - Country:US
Practice Address - Phone:719-562-9200
Practice Address - Fax:719-584-2353
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0081267163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control