Healthcare Provider Details

I. General information

NPI: 1790370609
Provider Name (Legal Business Name): YVONNE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 04/22/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 POPLAR ST
LEBANON PA
17042-6636
US

IV. Provider business mailing address

2120 WALNUT ST
LEBANON PA
17042-4409
US

V. Phone/Fax

Practice location:
  • Phone: 717-450-7650
  • Fax:
Mailing address:
  • Phone: 717-644-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number25453110
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: