Individual
JOHN HERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
413 LILLY RD NE, OLYMPIA, WA 98506-5133
(360) 491-9480
Mailing address
PO BOX 5007, LACEY, WA 98509-5007
(800) 599-0166
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1016774
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0153539
WA L & I
—
01
—
1659HE
REGENCE BS
—
05
—
8358236
—
WA
01
—
8935586
WA CRIME VICTIMS
—
01
—
A012
CHAMPUS
—
Enumeration date
06/09/2006
Last updated
11/27/2007
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