Healthcare Provider Details

I. General information

NPI: 1316086200
Provider Name (Legal Business Name): SHARLENE HERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E COLUMBUS AVE
SPRINGFIELD MA
01105-2506
US

IV. Provider business mailing address

502 MEADOWECREST CIR
LUDLOW MA
01056-1489
US

V. Phone/Fax

Practice location:
  • Phone: 413-827-8959
  • Fax: 413-827-7015
Mailing address:
  • Phone: 413-827-8959
  • Fax: 413-827-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN143012PC
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: