Provider Demographics
NPI:1922553726
Name:HERNANDEZ, ADRIANA MARIA (CNM, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CNM, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870777
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3035 E PALMER WASILLA HWY STE 401
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7274
Practice Address - Country:US
Practice Address - Phone:888-382-1897
Practice Address - Fax:888-959-6529
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113099363LP0808X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1652157Medicaid