Provider Demographics
NPI:1134393424
Name:HERNANDEZ, DOREEN L (LPN)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 E HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1318
Mailing Address - Country:US
Mailing Address - Phone:414-266-2000
Mailing Address - Fax:
Practice Address - Street 1:9000 W. WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:MILW.
Practice Address - State:WI
Practice Address - Zip Code:53201
Practice Address - Country:US
Practice Address - Phone:414-266-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30993031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse