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General NPI Number Information
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NPI Number | 1700397163
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Entity Type | Individual
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Provider Name | MANUEL P HERNANDEZ CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 500 LILLY RD NE STE 150
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City | OLYMPIA
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State | WA
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Zip | 98506
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Country | US
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Telephone | 360-413-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 500 LILLY RD NE STE 204
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City | OLYMPIA
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State | WA
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Zip | 98506-5197
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Country | US
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Telephone | 360-413-8191
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Fax | 253-682-2427
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 108991
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP60909561
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License Number State | WA
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