Provider Demographics
NPI:1871222430
Name:HERNANDEZ, ELISABETH MEEHNA (MSN RN APRN-CNS CCM)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:MEEHNA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSN RN APRN-CNS CCM
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:MEEHNA
Other - Last Name:HERNANDEZ-GREENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, RN APRN-CNS CCM
Mailing Address - Street 1:2555 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1667
Mailing Address - Country:US
Mailing Address - Phone:708-666-0030
Mailing Address - Fax:
Practice Address - Street 1:2677 WILLAKENZIE RD STE 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4873
Practice Address - Country:US
Practice Address - Phone:708-666-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202213113CNS-PP364SA2100X
OR201406369RN163WC0400X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202213113CNS-PPOtherAPRN LICENSE