Provider Demographics
NPI:1538851423
Name:HERNANDEZ, WENDY LILLISTON (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LILLISTON
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 1:12185 OAK CT
Mailing Address - Street 2:
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350-2423
Mailing Address - Country:US
Mailing Address - Phone:757-350-1227
Mailing Address - Fax:
Practice Address - Street 1:1600 SEABEE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8952
Practice Address - Country:US
Practice Address - Phone:757-763-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001153801163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management