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General NPI Number Information
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NPI Number | 1316330103
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Entity Type | Individual
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Provider Name | CRYSTAL LEE HERNANDEZ N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 15641 79TH ST
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City | HOWARD BEACH
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State | NY
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Zip | 11414-2502
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Country | US
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Telephone | 347-754-1245
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Fax |
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Provider Business Mailing Address
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Address Line | 34 ROOSEVELT AVE UNIT B
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City | CARTERET
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State | NJ
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Zip | 07008-2417
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 306906
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License Number State | NY
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