Individual
JACOB MANUEL HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
260 2ND AVE E, TWIN FALLS, ID 83301-6242
(208) 732-0959
Mailing address
260 2ND AVE E, TWIN FALLS, ID 83301-6242
(208) 732-0959
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
46268
ID
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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