Provider Demographics
NPI:1316469448
Name:HERRON, ARIEL JESSE (CNM)
Entity type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:JESSE
Last Name:HERRON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:ARIELLE
Other - Middle Name:
Other - Last Name:HERRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:191 STUART DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3965
Mailing Address - Country:US
Mailing Address - Phone:860-302-0967
Mailing Address - Fax:
Practice Address - Street 1:388 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4735
Practice Address - Country:US
Practice Address - Phone:860-649-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000420367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife