Healthcare Provider Details

I. General information

NPI: 1194581439
Provider Name (Legal Business Name): ALEXANDER HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST SURGICAL INTENSIVE CARE UNIT
BALTIMORE MD
21201-1590
US

V. Phone/Fax

Practice location:
  • Phone: 301-751-3766
  • Fax:
Mailing address:
  • Phone: 410-328-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR211834
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCS00228
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR211834
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: