Provider Demographics
NPI:1497523468
Name:HERNANDEZ, CAROLYN (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MOBILE MNR
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-9710
Mailing Address - Country:US
Mailing Address - Phone:707-291-2386
Mailing Address - Fax:707-261-0849
Practice Address - Street 1:13 MOBILE MNR
Practice Address - Street 2:
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508-9710
Practice Address - Country:US
Practice Address - Phone:707-291-2386
Practice Address - Fax:707-261-0849
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95183175163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant