Provider Demographics
NPI:1174111363
Name:HERBIN, MONTRAVON LATISE
Entity type:Individual
Prefix:
First Name:MONTRAVON
Middle Name:LATISE
Last Name:HERBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S ELM ST STE 328
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2681
Mailing Address - Country:US
Mailing Address - Phone:336-491-9006
Mailing Address - Fax:
Practice Address - Street 1:301 S ELM ST STE 328
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2681
Practice Address - Country:US
Practice Address - Phone:336-491-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist