=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003145954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH MARIE HERNANDEZ RN, MSN, WHCNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2009
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4503 S ZARZAMORA ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78211-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-644-8600
-----------------------------------------------------
Fax | 210-644-8625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 903 W MARTIN ST # MS 49-2
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-0903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-358-5909
-----------------------------------------------------
Fax | 210-358-5940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP1700X
-----------------------------------------------------
Taxonomy Name | Perinatal Nurse Practitioner
-----------------------------------------------------
License Number | 695964
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | AP118486
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------