Provider Demographics
NPI:1346763356
Name:HERNANDEZ, BERNICE CARLA (CHA-II)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:CARLA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CHA-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4043
Mailing Address - Street 2:
Mailing Address - City:TWIN HILLS
Mailing Address - State:AK
Mailing Address - Zip Code:99576-4043
Mailing Address - Country:US
Mailing Address - Phone:907-525-4326
Mailing Address - Fax:907-525-4325
Practice Address - Street 1:200 TWIN HILLS ROAD
Practice Address - Street 2:
Practice Address - City:TWIN HILLS
Practice Address - State:AK
Practice Address - Zip Code:99576-4043
Practice Address - Country:US
Practice Address - Phone:907-525-4326
Practice Address - Fax:907-525-4325
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker