MEDICARE: LAURA HERNANDEZ FNP-C

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	363LF0000X	Family Nurse Practitioner	277.004193	IL

General Provider Information

NPI Number	:	1851965222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HERNANDEZ FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	708-292-7000
Fax Number	:	708-887-5874

Provider Business Practice Location Address
First Line	:	1401 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1735
Country	:	US
Telephone Number	:	708-292-7000
Fax Number	:	708-887-5874

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

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	01/16/2026

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