Provider Demographics
NPI:1609279298
Name:HERNANDEZ, AMY MARIE (PA-C, MS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:875 OAK ST SE STE 4030
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3984
Mailing Address - Country:US
Mailing Address - Phone:503-561-6444
Mailing Address - Fax:
Practice Address - Street 1:3025 RYAN DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5057
Practice Address - Country:US
Practice Address - Phone:503-540-9999
Practice Address - Fax:503-540-3105
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA169940363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical