Provider Demographics
NPI:1730696139
Name:HERNANDEZ, AMANDA R (LPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:FINKENAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 FLINTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2616
Mailing Address - Country:US
Mailing Address - Phone:631-687-9886
Mailing Address - Fax:
Practice Address - Street 1:13 FLINTLOCK DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2616
Practice Address - Country:US
Practice Address - Phone:631-687-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330081-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse