Provider Demographics
NPI:1033100953
Name:MEADE, BERNADETTE VERONICA (DO)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:VERONICA
Last Name:MEADE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3046
Mailing Address - Country:US
Mailing Address - Phone:307-688-2600
Mailing Address - Fax:307-685-3079
Practice Address - Street 1:501 S. BURMA AVE.
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3246
Practice Address - Country:US
Practice Address - Phone:307-688-3636
Practice Address - Fax:307-688-7920
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8068A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine