Provider Demographics
NPI:1043781370
Name:HERNANDEZ, DAVID (LVN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:TENAHA
Mailing Address - State:TX
Mailing Address - Zip Code:75974-5402
Mailing Address - Country:US
Mailing Address - Phone:936-332-7329
Mailing Address - Fax:
Practice Address - Street 1:164 WILLOW DR
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-5402
Practice Address - Country:US
Practice Address - Phone:936-332-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325005164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse