MEDICARE: STACY M HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1740904770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY M HERNANDEZ

Provider Business Mailing Address
First Line	:	3578 HARTSEL DR STE E PMB 444
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-500-6928
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 PIONEER MESA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-8804
Country	:	US
Telephone Number	:	719-500-6928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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Directions to “ STACY M HERNANDEZ ” Practice Location

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