Provider Demographics
NPI:1073279527
Name:NEPOMUCENO, BERNADETTE (NP-C)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:NEPOMUCENO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARKVIEW TER APT SUITE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3709
Mailing Address - Country:US
Mailing Address - Phone:203-606-3038
Mailing Address - Fax:
Practice Address - Street 1:15 PARKVIEW TER APT SUITE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3709
Practice Address - Country:US
Practice Address - Phone:203-606-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01212100363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology