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General NPI Number Information
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NPI Number | 1962199539
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Entity Type | Individual
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Provider Name | ANDREW NICHOLAS HERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 815 CAMPUS DR
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City | JOLIET
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State | IL
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Zip | 60435-8573
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Country | US
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Telephone | 630-857-6883
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Fax |
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Provider Business Mailing Address
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Address Line | 2843 WINDSOR DR APT 208
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City | LISLE
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State | IL
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Zip | 60532-6204
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Country | US
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Telephone | 630-857-6883
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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