Provider Demographics
NPI:1215217591
Name:HERNANDEZ, ORLANDO RAFAEL (RN)
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:RAFAEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2821
Mailing Address - Country:US
Mailing Address - Phone:920-918-3446
Mailing Address - Fax:
Practice Address - Street 1:1617 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2821
Practice Address - Country:US
Practice Address - Phone:920-918-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165858-30374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide