Basic Information
| Provider Information | |||||||||
| NPI: | 1093888257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KORTHAS | ||||||||
| OtherFirstName: | MICHELE | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 415258 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022415258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667406774 | ||||||||
| FaxNumber: | 7819376442 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784631050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1983 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.