Provider Demographics
NPI:1114364932
Name:HERNANDEZ-STEWART, DORA MARICELA (NP)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:MARICELA
Last Name:HERNANDEZ-STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3891
Mailing Address - Country:US
Mailing Address - Phone:575-528-5180
Mailing Address - Fax:
Practice Address - Street 1:1170 N SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2371
Practice Address - Country:US
Practice Address - Phone:575-528-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily