Healthcare Provider Details

I. General information

NPI: 1194281360
Provider Name (Legal Business Name): LILETH HERNANDEZ ENCARNACION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

1619 MCNAMARA DR
DELAWARE OH
43015-7604
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-5858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN294215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: