Healthcare Provider Details

I. General information

NPI: 1134393424
Provider Name (Legal Business Name): DOREEN L. HERNANDEZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W. WISCONSIN AVE.
MILW. WI
53201
US

IV. Provider business mailing address

2627 E HOLMES AVE
CUDAHY WI
53110-1318
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2000
  • Fax:
Mailing address:
  • Phone: 414-266-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number30993031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: