Provider Demographics
NPI:1245223254
Name:HERNANDEZ, MARTHA ROSARIO (RN,MS,APRN,)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ROSARIO
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN,MS,APRN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8687 E VIA DE VENTURA
Mailing Address - Street 2:318
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3347
Mailing Address - Country:US
Mailing Address - Phone:480-905-8755
Mailing Address - Fax:480-905-8851
Practice Address - Street 1:8687 E VIA DE VENTURA
Practice Address - Street 2:318
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3347
Practice Address - Country:US
Practice Address - Phone:480-905-8755
Practice Address - Fax:480-905-8851
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036999363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN036999OtherLICENSE
AZRN036999OtherLICENSE
AZMH0316972OtherDEA