Provider Demographics
NPI:1114144128
Name:HERNANDEZ, DIANE (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1111
Mailing Address - Country:US
Mailing Address - Phone:602-257-3898
Mailing Address - Fax:602-257-2954
Practice Address - Street 1:123 N 13TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1111
Practice Address - Country:US
Practice Address - Phone:602-257-3898
Practice Address - Fax:602-257-2954
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN067896163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool