Provider Demographics
NPI:1194593731
Name:HERNANDEZ, CHARLOTTE DIANE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:DIANE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:902 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-1797
Mailing Address - Country:US
Mailing Address - Phone:972-749-6805
Mailing Address - Fax:972-749-6801
Practice Address - Street 1:902 SHADY LN
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-1797
Practice Address - Country:US
Practice Address - Phone:972-749-6805
Practice Address - Fax:972-749-6801
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676402163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics