Basic Information
| Provider Information | |||||||||
| NPI: | 1508156084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | BERNADETTE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 S TELSHOR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880115069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755215457 | ||||||||
| FaxNumber: | 5755215471 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 S TELSHOR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880115069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755215457 | ||||||||
| FaxNumber: | 5755215471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2011 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP120220 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 653892 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | AP120220 | 01 | TX | ACUTE CARE NURSE PRACTITIONER | OTHER |