Provider Demographics
NPI:1073921631
Name:HALL, BERNADETTE M (RN, BSN)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2250
Mailing Address - Country:US
Mailing Address - Phone:716-465-8513
Mailing Address - Fax:
Practice Address - Street 1:10570 BERGTOLD RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2105
Practice Address - Country:US
Practice Address - Phone:716-759-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674703163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse