Provider Demographics
NPI:1033272646
Name:HERNANDEZ, NORMA M
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18220 WEST NORTH COURT
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355
Mailing Address - Country:US
Mailing Address - Phone:623-412-7857
Mailing Address - Fax:
Practice Address - Street 1:18220 WEST NORTH COURT
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355
Practice Address - Country:US
Practice Address - Phone:623-412-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ118273747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider