Provider Demographics
NPI:1043921570
Name:ROCHELLE-BERNHARDT, KATHY ELISE (RDH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ELISE
Last Name:ROCHELLE-BERNHARDT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ELISE
Other - Last Name:ROCHELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:LANEXA
Mailing Address - State:VA
Mailing Address - Zip Code:23089-0101
Mailing Address - Country:US
Mailing Address - Phone:757-871-9796
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1806 NAVAL WEAPONS STATION
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23691
Practice Address - Country:US
Practice Address - Phone:757-953-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08766124Q00000X
VA0402002723124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0402002723OtherLICENSE
NC08766OtherLICENSE