Individual
NINA JEAN HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
8208 LOUISIANA BLVD NE, SUITE C, ALBUQUERQUE, NM 87113-1757
(505) 858-1222
(505) 858-1224
Mailing address
8208 LOUISIANA BLVD NE, SUITE C, ALBUQUERQUE, NM 87113-1757
(505) 858-1222
(505) 858-1224
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP01217
NM
363L00000X
Nurse Practitioner
R49167
NM
363LA2100X
Acute Care Nurse Practitioner
R49167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2006009954
ANCC CERTIFICATION
MD
05
—
87657317
—
NM
01
—
R49167
BNE LICENSE
TX
Enumeration date
01/26/2007
Last updated
05/20/2016
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