1730338187 NPI number — SUSAN L HERNANDEZ APRN

Table of content: SUSAN L HERNANDEZ APRN (NPI 1730338187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730338187 NPI number — SUSAN L HERNANDEZ APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
SUSAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730338187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 SHACKLEFORD WEST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211-3714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-664-5860
Provider Business Mailing Address Fax Number:
501-664-0889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 SECTION LINE RD
Provider Second Line Business Practice Location Address:
SUITE A , C, E
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-664-5860
Provider Business Practice Location Address Fax Number:
501-664-0889
Provider Enumeration Date:
09/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  A003154 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 183467758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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