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General NPI Number Information
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NPI Number | 1023625878
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Entity Type | Individual
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Provider Name | NALLELY HERNANDEZ CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 333 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2497
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Country | US
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Telephone | 215-214-1782
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Fax |
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Provider Business Mailing Address
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Address Line | 4998 MASTER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-4521
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Country | US
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Telephone | 267-439-1105
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Fax |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | SPO22066
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License Number State | PA
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