Provider Demographics
NPI:1093933012
Name:BERNABE, MARY ELAINE (CPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:BERNABE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-0499
Mailing Address - Country:US
Mailing Address - Phone:360-608-7590
Mailing Address - Fax:
Practice Address - Street 1:507 NE TWIN FALLS AVE
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-0499
Practice Address - Country:US
Practice Address - Phone:360-608-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay