Provider Demographics
NPI:1972055226
Name:HERNANDEZ, MOLLY MARIE (ARNP, CNM)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34509 9TH AVE S STE 207
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8709
Mailing Address - Country:US
Mailing Address - Phone:253-815-9595
Mailing Address - Fax:253-426-4322
Practice Address - Street 1:34509 9TH AVE S STE 207
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8709
Practice Address - Country:US
Practice Address - Phone:253-815-9595
Practice Address - Fax:253-426-4322
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00112651390200000X
WAAP60791431367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2097755Medicaid
WAAP60791431OtherSTATE OF WA TAXONOMY CODE : 367A00000X