Provider Demographics
NPI:1154810588
Name:HERRON, MAGGIE ANNE (BSN, RN)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ANNE
Last Name:HERRON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5889 RUDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-7133
Mailing Address - Country:US
Mailing Address - Phone:731-780-7500
Mailing Address - Fax:
Practice Address - Street 1:950 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-2647
Practice Address - Country:US
Practice Address - Phone:731-772-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN224169163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health