Provider Demographics
NPI:1003256793
Name:CARMONA, BERNADETTE NICACIO (LVN)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:NICACIO
Last Name:CARMONA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 SCOTT AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-2945
Mailing Address - Country:US
Mailing Address - Phone:559-417-9993
Mailing Address - Fax:
Practice Address - Street 1:1370 SCOTT AVE APT 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-2945
Practice Address - Country:US
Practice Address - Phone:559-417-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN235592164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse