Healthcare Provider Details

I. General information

NPI: 1063052249
Provider Name (Legal Business Name): PENNI HERNANDEZ RN, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 W SYCAMORE CT
LOUISVILLE CO
80027-2229
US

IV. Provider business mailing address

468 W SYCAMORE CT
LOUISVILLE CO
80027-2229
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-3224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN.0002552-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: