Provider Demographics
NPI:1871386623
Name:HERNANDEZ MORAN, FERNANDA MICHELLE
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:MICHELLE
Last Name:HERNANDEZ MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SAINT OLAF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1574
Mailing Address - Country:US
Mailing Address - Phone:507-649-8444
Mailing Address - Fax:
Practice Address - Street 1:4500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3736
Practice Address - Country:US
Practice Address - Phone:216-432-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator