Individual
HEATHER NICOLE HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2570 NW EDENBOWER BLVD, ROSEBURG, OR 97471-6214
(541) 733-5403
Mailing address
333 CEDAR ST, NEW HAVEN, CT 06510-3206
(541) 733-5403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA219551
OR
Other
Enumeration date
04/15/2024
Last updated
07/31/2024
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