Provider Demographics
NPI:1235387655
Name:VAN WIE, BERNADETTE LOIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:LOIS
Last Name:VAN WIE
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 1:465 N PERRY ST
Mailing Address - Street 2:CONTINUING DAY TREATMENT (CDTP)
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1014
Mailing Address - Country:US
Mailing Address - Phone:518-736-3962
Mailing Address - Fax:518-762-0974
Practice Address - Street 1:465 N PERRY ST
Practice Address - Street 2:CONTINUING DAY TREATMENT (CDTP)
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1014
Practice Address - Country:US
Practice Address - Phone:518-736-3962
Practice Address - Fax:518-762-0974
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417321-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult