Provider Demographics
NPI:1497713820
Name:HERNANDEZ, LYNN JOANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:JOANNE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BURRIS STREET
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174
Mailing Address - Country:US
Mailing Address - Phone:864-414-5334
Mailing Address - Fax:
Practice Address - Street 1:1224 W ROOSEVELT BLVD
Practice Address - Street 2:UNION COUNTY HEALTH DEPT.
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2820
Practice Address - Country:US
Practice Address - Phone:704-296-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01251207Q00000X
SC24034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0114265OtherCIGNA
NC5901960Medicaid
NC7342738OtherAETNA
NC7342738OtherAETNA
SCAA01223365Medicare ID - Type Unspecified
NCH95715Medicare UPIN