Basic Information
| Provider Information | |||||||||
| NPI: | 1972055226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34509 9TH AVE S STE 207 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538159595 | ||||||||
| FaxNumber: | 2534264322 | ||||||||
| Practice Location | |||||||||
| Address1: | 34509 9TH AVE S STE 207 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538159595 | ||||||||
| FaxNumber: | 2534264322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2016 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RN00112651 | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367A00000X | AP60791431 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 2097755 | 05 | WA | MEDICAID | AP60791431 | 01 | WA | STATE OF WA TAXONOMY CODE : 367A00000X | OTHER |