Provider Demographics
NPI:1427889187
Name:HERNANDEZ, CIARA LUCILLE (CHA/1)
Entity type:Individual
Prefix:MS
First Name:CIARA
Middle Name:LUCILLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CHA/1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NORTHERN LIGHTS AVENUE
Mailing Address - Street 2:P.O. BOX 4012
Mailing Address - City:TWIN HILLS
Mailing Address - State:AK
Mailing Address - Zip Code:99576-4012
Mailing Address - Country:US
Mailing Address - Phone:907-493-2089
Mailing Address - Fax:
Practice Address - Street 1:6000 KANAKNAK ROAD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0130
Practice Address - Country:US
Practice Address - Phone:907-525-4326
Practice Address - Fax:907-525-4325
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker