Provider Demographics
NPI:1780562850
Name:HERNANDEZ, GLENDY MIA (LPN)
Entity type:Individual
Prefix:
First Name:GLENDY
Middle Name:MIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 HOOD RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5939
Mailing Address - Country:US
Mailing Address - Phone:571-778-7561
Mailing Address - Fax:
Practice Address - Street 1:8427 DORSEY CIR STE 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4596
Practice Address - Country:US
Practice Address - Phone:703-330-7517
Practice Address - Fax:703-656-4893
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002104312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse