Provider Demographics
NPI:1881304160
Name:HERNANDEZ, DA'SHA (MT)
Entity type:Individual
Prefix:
First Name:DA'SHA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2049
Mailing Address - Country:US
Mailing Address - Phone:509-884-4357
Mailing Address - Fax:
Practice Address - Street 1:603 N MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2049
Practice Address - Country:US
Practice Address - Phone:509-884-4357
Practice Address - Fax:509-888-4601
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61384174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist