Healthcare Provider Details

I. General information

NPI: 1831963065
Provider Name (Legal Business Name): MIKAELA L HERNANDEZ AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E21
HERMISTON OR
97838-8603
US

IV. Provider business mailing address

600 NW 11TH ST STE E21
HERMISTON OR
97838-8603
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-2270
  • Fax: 541-303-8445
Mailing address:
  • Phone: 541-567-2270
  • Fax: 541-303-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number31126
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: