Provider Demographics
NPI:1124638671
Name:HERNANDEZ, GWINNETTE R (NP)
Entity type:Individual
Prefix:MRS
First Name:GWINNETTE
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1019 821 COUNTY RD RT 64 STE 1
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903
Mailing Address - Country:US
Mailing Address - Phone:607-331-1600
Mailing Address - Fax:607-442-1209
Practice Address - Street 1:1019 821 COUNTY RD RT 64 STE 1
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903
Practice Address - Country:US
Practice Address - Phone:607-331-1600
Practice Address - Fax:607-442-1209
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403094363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health