Provider Demographics
NPI:1275082232
Name:HERNAN, CYNTHIA CAROL
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CAROL
Last Name:HERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 132ND STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-5538
Mailing Address - Country:US
Mailing Address - Phone:253-841-8755
Mailing Address - Fax:253-841-8684
Practice Address - Street 1:15102 122ND AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-3419
Practice Address - Country:US
Practice Address - Phone:253-841-8755
Practice Address - Fax:253-841-8684
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00040781164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse