MEDICARE: NADIA MARIE HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1114266699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA MARIE HERNANDEZ

Provider Business Mailing Address
First Line	:	3421 121ST PL
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-4264
Country	:	US
Telephone Number	:	608-338-9468
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 121ST PL
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-4264
Country	:	US
Telephone Number	:	608-338-9468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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Directions to “ NADIA MARIE HERNANDEZ ” Practice Location

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