Provider Demographics
NPI:1174271068
Name:HERNANDEZ, JAMIE (RN, CCM)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43900 SE DEVERELL RD
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-9766
Mailing Address - Country:US
Mailing Address - Phone:503-333-0724
Mailing Address - Fax:877-835-2648
Practice Address - Street 1:43900 SE DEVERELL RD
Practice Address - Street 2:
Practice Address - City:CORBETT
Practice Address - State:OR
Practice Address - Zip Code:97019-9766
Practice Address - Country:US
Practice Address - Phone:503-333-0724
Practice Address - Fax:877-835-2648
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201243239163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management