Provider Demographics
NPI:1669260675
Name:HERNANDEZ, BETZUA (APRN-FNP-BC)
Entity type:Individual
Prefix:
First Name:BETZUA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:APRN-FNP-BC
Other - Prefix:MRS
Other - First Name:BETZUA
Other - Middle Name:
Other - Last Name:AMBRIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3633 S 57TH CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4236
Mailing Address - Country:US
Mailing Address - Phone:708-400-6236
Mailing Address - Fax:
Practice Address - Street 1:3633 S 57TH CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4236
Practice Address - Country:US
Practice Address - Phone:708-400-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty