Provider Demographics
NPI:1275254393
Name:BANTON, BERNADETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:
Last Name:BANTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2801
Mailing Address - Country:US
Mailing Address - Phone:860-328-4808
Mailing Address - Fax:
Practice Address - Street 1:29 FOREST LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2801
Practice Address - Country:US
Practice Address - Phone:860-328-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse