Provider Demographics
NPI:1043427404
Name:HARLOW, BERNADETTE ANN (PMHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ANN
Last Name:HARLOW
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 TWAIN AVE APT 164
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3470
Mailing Address - Country:US
Mailing Address - Phone:571-225-2843
Mailing Address - Fax:619-556-8627
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-4826
Practice Address - Country:US
Practice Address - Phone:619-556-8090
Practice Address - Fax:619-556-8627
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165791363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily