Provider Demographics
NPI:1255011961
Name:HERNANDEZ, NOELLE L
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 HUMMINGBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8606
Mailing Address - Country:US
Mailing Address - Phone:720-438-1245
Mailing Address - Fax:
Practice Address - Street 1:1823 SUNSET PL STE C
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6544
Practice Address - Country:US
Practice Address - Phone:720-449-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician