Provider Demographics
NPI:1093085995
Name:CAPULONG, BERNADETTE D (RN)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:D
Last Name:CAPULONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 FINKS HIDEAWAY RD
Mailing Address - Street 2:APARTMENT 4, BLDG. 1
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2389
Mailing Address - Country:US
Mailing Address - Phone:318-345-1488
Mailing Address - Fax:318-345-1488
Practice Address - Street 1:224 FINKS HIDEAWAY RD
Practice Address - Street 2:APARTMENT 4, BLDG. 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2389
Practice Address - Country:US
Practice Address - Phone:318-345-1488
Practice Address - Fax:318-345-1488
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN130724163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse