Provider Demographics
NPI:1124311840
Name:HERNANDEZ, ELAINE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:MARIE
Other - Last Name:OXSPRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9330 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2858
Mailing Address - Country:US
Mailing Address - Phone:253-620-5015
Mailing Address - Fax:253-620-5831
Practice Address - Street 1:9330 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2858
Practice Address - Country:US
Practice Address - Phone:253-620-5015
Practice Address - Fax:253-620-5831
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00120841163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health