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General NPI Number Information
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NPI Number | 1013868967
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Entity Type | Individual
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Provider Name | MARY DIANNE HERNANDEZ CRISTOBAL RN
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Gender | Female
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 1300 PEACHTREE INDUSTRIAL BLVD STE 4203
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City | SUWANEE
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State | GA
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Zip | 30024-4540
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Country | US
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Telephone | 770-831-3018
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Fax | 770-831-3669
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Provider Business Mailing Address
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Address Line | 10719 PEAK VALLEY WAY APT 524
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City | KNOXVILLE
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State | TN
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Zip | 37932-4462
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Country | US
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Telephone | 770-831-3018
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Fax | 770-831-3669
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 264848
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License Number State | TN
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