Provider Demographics
NPI:1922843036
Name:MARCHAN HERNANDEZ, FERNANDA RAQUEL (SA-C)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:RAQUEL
Last Name:MARCHAN HERNANDEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THUNDER HILL CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-6254
Mailing Address - Country:US
Mailing Address - Phone:763-346-5702
Mailing Address - Fax:
Practice Address - Street 1:11 THUNDER HILL CT
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-6254
Practice Address - Country:US
Practice Address - Phone:763-346-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24-334246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant