Provider Demographics
NPI:1588786222
Name:HERNANDEZ, DENNICE (ANP)
Entity type:Individual
Prefix:
First Name:DENNICE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-0819
Mailing Address - Country:US
Mailing Address - Phone:541-935-2035
Mailing Address - Fax:541-935-6608
Practice Address - Street 1:25045 DUNHAM AVENUE
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-0819
Practice Address - Country:US
Practice Address - Phone:541-935-2035
Practice Address - Fax:541-935-6608
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090006100N3ANP PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health