Provider Demographics
NPI:1447425517
Name:HERRERA, STACY LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 SCARLET SAGE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1019
Mailing Address - Country:US
Mailing Address - Phone:719-566-8075
Mailing Address - Fax:
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-583-4308
Practice Address - Fax:719-583-4375
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130777163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)