Provider Demographics
NPI:1851965222
Name:HERNANDEZ, LAURA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AUBURN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4328
Mailing Address - Country:US
Mailing Address - Phone:216-317-1285
Mailing Address - Fax:877-595-6270
Practice Address - Street 1:4400 PRIME PKWY
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7003
Practice Address - Country:US
Practice Address - Phone:224-535-1821
Practice Address - Fax:877-595-6270
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner