Provider Demographics
NPI:1881698603
Name:HERNANDEZ, MYRIAM I (PNP)
Entity type:Individual
Prefix:MS
First Name:MYRIAM
Middle Name:I
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROTUNDA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2714
Mailing Address - Country:US
Mailing Address - Phone:732-376-6032
Mailing Address - Fax:732-376-6288
Practice Address - Street 1:D1 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3335
Practice Address - Country:US
Practice Address - Phone:732-238-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07754800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8103607OtherPROVIDER NUMBER
NJ8103607OtherPROVIDER NUMBER