Basic Information
Provider Information | |||||||||
NPI: | 1861840514 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HERRERA | ||||||||
FirstName: | VILMA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | AGNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALARCON | ||||||||
OtherFirstName: | VILMA | ||||||||
OtherMiddleName: | JOAQUIN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 500 15TH AVE S | ||||||||
Address2: |   | ||||||||
City: | GREAT FALLS | ||||||||
State: | MT | ||||||||
PostalCode: | 594054324 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4067318888 | ||||||||
FaxNumber: | 4067318318 | ||||||||
Practice Location | |||||||||
Address1: | 500 15TH AVE S | ||||||||
Address2: |   | ||||||||
City: | GREAT FALLS | ||||||||
State: | MT | ||||||||
PostalCode: | 594054324 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4068685147 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/02/2016 | ||||||||
LastUpdateDate: | 05/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/04/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 103362 | MT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.