Provider Demographics
NPI:1902263601
Name:HERNANDEZ, HEATHER (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEAVERTOWN RD
Mailing Address - Street 2:UNIT 122
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-2260
Mailing Address - Country:US
Mailing Address - Phone:717-926-0805
Mailing Address - Fax:
Practice Address - Street 1:1700 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7529
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN656784163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse