Provider Demographics
NPI:1811294572
Name:HERNANDEZ-CEBALLOS, VENIECE MELLISSA (RN)
Entity type:Individual
Prefix:MRS
First Name:VENIECE
Middle Name:MELLISSA
Last Name:HERNANDEZ-CEBALLOS
Suffix:
Gender:F
Credentials:RN
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 477
Mailing Address - Street 2:
Mailing Address - City:MONITOR
Mailing Address - State:WA
Mailing Address - Zip Code:98836-0477
Mailing Address - Country:US
Mailing Address - Phone:509-782-1718
Mailing Address - Fax:509-782-1718
Practice Address - Street 1:3263 ALLYN LN
Practice Address - Street 2:
Practice Address - City:MONITOR
Practice Address - State:WA
Practice Address - Zip Code:98815
Practice Address - Country:US
Practice Address - Phone:509-782-1718
Practice Address - Fax:509-782-1718
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603085613343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)