Provider Demographics
NPI:1992140677
Name:HERRERA, WILFREDO NICOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:NICOLAS
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1831
Mailing Address - Country:US
Mailing Address - Phone:865-331-2020
Mailing Address - Fax:865-331-1976
Practice Address - Street 1:501 19TH ST STE 401
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1831
Practice Address - Country:US
Practice Address - Phone:865-331-2020
Practice Address - Fax:865-331-1976
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133051207V00000X
TN64203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology