Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP1700X | Nurse Practitioner - Perinatal | 695964 | TX |
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP118486 | TX |
NPI | 1003145954 |
---|---|
Provider Name | Elizabeth Marie Hernandez |
First Address | Dallas, TX 75373-4812 |
Second Address | San Antonio, TX 78211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2009 |
Last Update Date | 26/02/2021 |