MEDICARE: JOLENE MARIE HERNANDEZ R.N

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN550959	PA

General Provider Information

NPI Number	:	1811003783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLENE MARIE HERNANDEZ R.N

Provider Business Mailing Address
First Line	:	1800 WEST ST REAR
Second Line	:
City	:	HOMESTEAD
State	:	PA
Zip	:	15120-2578
Country	:	US
Telephone Number	:	412-462-9901
Fax Number	:	412-462-4901

Provider Business Practice Location Address
First Line	:	1800 WEST ST REAR
Second Line	:
City	:	HOMESTEAD
State	:	PA
Zip	:	15120-2578
Country	:	US
Telephone Number	:	412-462-9901
Fax Number	:	412-462-4901

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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