Provider Demographics
NPI:1861003204
Name:FERNANDEZ, LETICIA (APRN CNM)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6105
Mailing Address - Country:US
Mailing Address - Phone:928-341-9779
Mailing Address - Fax:928-341-9779
Practice Address - Street 1:1945 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6105
Practice Address - Country:US
Practice Address - Phone:928-341-4650
Practice Address - Fax:928-341-9779
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245121367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife