Provider Demographics
NPI:1477852390
Name:FERNANDEZ, ANTIONETTE YVONNE (LPN16653)
Entity type:Individual
Prefix:MRS
First Name:ANTIONETTE
Middle Name:YVONNE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LPN16653
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2053
Mailing Address - Street 2:
Mailing Address - City:BIG RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:92242-2053
Mailing Address - Country:US
Mailing Address - Phone:808-294-1069
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN STE 160
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2561
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN16653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse