Provider Demographics
NPI:1629716600
Name:HERNANDEZ, ANASTACIA DOMINGA (PSS)
Entity type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:DOMINGA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 CHARNELTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3430
Mailing Address - Country:US
Mailing Address - Phone:541-636-8918
Mailing Address - Fax:
Practice Address - Street 1:1270 CHARNELTON ST FL 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3430
Practice Address - Country:US
Practice Address - Phone:541-636-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000106670175T00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No175T00000XOther Service ProvidersPeer Specialist