Provider Demographics
NPI:1376310771
Name:BERNAL, JENNIFER HAYDEE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAYDEE
Last Name:BERNAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 DWIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3025
Mailing Address - Country:US
Mailing Address - Phone:908-770-6303
Mailing Address - Fax:
Practice Address - Street 1:405 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3025
Practice Address - Country:US
Practice Address - Phone:908-770-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18604300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse