Provider Demographics
NPI:1760372908
Name:HERNANDEZ, REINA LISETTE
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:LISETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 W 78TH ST TRLR 105
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4110
Mailing Address - Country:US
Mailing Address - Phone:308-627-0551
Mailing Address - Fax:
Practice Address - Street 1:702 8TH AVE UNIT 61
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-6693
Practice Address - Country:US
Practice Address - Phone:308-627-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant