MEDICARE: MICHELLE ALEXIS 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	364SC1501X	Community Health/Public Health Clinical Nurse Specialist	26NP07951300	NJ

General Provider Information

NPI Number	:	1871280032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ALEXIS HERNANDEZ

Provider Business Mailing Address
First Line	:	43 BERGEN BLVD
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1968
Country	:	US
Telephone Number	:	201-681-6254
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 KENNEDY BLVD
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-2525
Country	:	US
Telephone Number	:	201-864-9129
Fax Number	:

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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