Provider Demographics
NPI:1225254360
Name:MODELO, BERNADETTE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARIE
Last Name:MODELO
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:PO BOX 29
Mailing Address - Street 2:UNIT 36
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0029
Mailing Address - Country:US
Mailing Address - Phone:907-852-3014
Mailing Address - Fax:907-852-2016
Practice Address - Street 1:1296 AGVIK ST.
Practice Address - Street 2:SAMMUEL SIMMONDS MEMORIAL HOSPITAL
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723-0029
Practice Address - Country:US
Practice Address - Phone:907-852-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19425163WC0200X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK163WMedicaid