Provider Demographics
NPI:1194338384
Name:HERRERA, EMILY LOUISE (BSN, RN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LOUISE
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 34TH ST SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1716
Mailing Address - Country:US
Mailing Address - Phone:774-284-2696
Mailing Address - Fax:
Practice Address - Street 1:450 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3206
Practice Address - Country:US
Practice Address - Phone:505-994-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM400657163WS0200X
NM60780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool