Provider Demographics
NPI:1265685861
Name:TERRY, BERNETA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:BERNETA
Middle Name:MARIE
Last Name:TERRY
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 1:4 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-3109
Mailing Address - Country:US
Mailing Address - Phone:315-889-9023
Mailing Address - Fax:
Practice Address - Street 1:4 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13160-3109
Practice Address - Country:US
Practice Address - Phone:315-889-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22372617163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health