Provider Demographics
NPI:1689456550
Name:HERNANDEZ, OLIVA (HEALTH EDUCATOR)
Entity Type:Individual
Prefix:
First Name:OLIVA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13019 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-7712
Mailing Address - Country:US
Mailing Address - Phone:360-660-6463
Mailing Address - Fax:
Practice Address - Street 1:13019 WAGNER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-7712
Practice Address - Country:US
Practice Address - Phone:360-660-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty