Individual
ANTONIA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP, RN
Contact information
Practice address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 863-1820
Mailing address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 863-1820
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
R67661
NM
363LP0200X
Pediatric Nurse Practitioner
Primary
59822
NM
Other
Enumeration date
09/24/2015
Last updated
06/03/2020
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