Provider Demographics
NPI:1013737139
Name:RODRIGUEZ HERNANDEZ, ISABEL (REGISTER NURSE-IBCLC)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:RODRIGUEZ HERNANDEZ
Suffix:
Gender:F
Credentials:REGISTER NURSE-IBCLC
Other - Prefix:
Other - First Name:ISABEL
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTER NURSE-IBCLC
Mailing Address - Street 1:3406 VETERANS MEMORIAL DR APT 701
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6236
Mailing Address - Country:US
Mailing Address - Phone:618-204-3408
Mailing Address - Fax:
Practice Address - Street 1:3406 VETERANS MEMORIAL DR APT 701
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6236
Practice Address - Country:US
Practice Address - Phone:618-204-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041553560251J00000X
NY853868251J00000X
ILL-59293174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No251J00000XAgenciesNursing Care