Provider Demographics
NPI:1215243522
Name:HING-HERNANDEZ, AMANDA LAUREN (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAUREN
Last Name:HING-HERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LAUREN
Other - Last Name:HING-KANGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:13161 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LE GRAND
Practice Address - State:CA
Practice Address - Zip Code:95333-9766
Practice Address - Country:US
Practice Address - Phone:209-389-1900
Practice Address - Fax:209-389-1907
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 19489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN 756696OtherRN LICENSE
CANP 19489OtherCA LICENSE