Provider Demographics
NPI:1275106023
Name:BERNACET, WILMAGIE N (LPN)
Entity Type:Individual
Prefix:MISS
First Name:WILMAGIE
Middle Name:N
Last Name:BERNACET
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3744
Mailing Address - Country:US
Mailing Address - Phone:203-819-3821
Mailing Address - Fax:
Practice Address - Street 1:109 VANCE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3744
Practice Address - Country:US
Practice Address - Phone:203-819-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42189164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse