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Individual
MARYLOU HERNANDEZ
Active
Individual
MARYLOU HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
013704
NY
363A00000X
Physician Assistant
Primary
PA10004360
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0163636
DEPT. OF LABOR & INDUSTRI
WA
01
—
0515HE
REGENCE BLUE SHIELD NUMBE
WA
05
—
8353773
—
WA
Enumeration date
01/26/2006
Last updated
07/13/2010
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