Provider Demographics
NPI:1194802751
Name:HERNANDEZ, MARTI J (BSN RN PHNII CLC)
Entity type:Individual
Prefix:MRS
First Name:MARTI
Middle Name:J
Last Name:HERNANDEZ
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Gender:F
Credentials:BSN RN PHNII CLC
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Mailing Address - Street 1:260 S KIPLING STREET
Mailing Address - Street 2:JEFFERSON COUNTY DEPT HEALTH & ENVIRONMENT
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-239-7018
Mailing Address - Fax:303-239-7088
Practice Address - Street 1:260 S KIPLING STREET
Practice Address - Street 2:JEFFERSON COUNTY DEPT HEALTH & ENVIRONMENT
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-239-7018
Practice Address - Fax:303-239-7088
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO89749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19555865Medicaid