Provider Demographics
NPI:1942442090
Name:HERNANDEZ, CARMEN MARIA (CARMEN HERNANDEZ)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CARMEN HERNANDEZ
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:JANECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NNP-BC
Mailing Address - Street 1:5392 S HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7433
Mailing Address - Country:US
Mailing Address - Phone:303-257-7452
Mailing Address - Fax:
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:303-839-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109420363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal