Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95010896 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 95010896 | CA |
NPI | 1003380452 |
---|---|
Provider Name | Ms. Stephanie D Hernandez |
First Address | Merced, CA 95341-6805 |
Second Address | Planada, CA 95365-8088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2019 |
Last Update Date | 25/01/2019 |