Provider Demographics
NPI:1093933251
Name:BERNATSKY, VANIA E (NP)
Entity Type:Individual
Prefix:MS
First Name:VANIA
Middle Name:E
Last Name:BERNATSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RANCHO RIO AVE
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9414
Mailing Address - Country:US
Mailing Address - Phone:831-724-1811
Mailing Address - Fax:
Practice Address - Street 1:598 BROWNS VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-0334
Practice Address - Country:US
Practice Address - Phone:831-763-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ228962Medicare ID - Type Unspecified