Provider Demographics
NPI:1396403614
Name:DANNUG, BERNADETH MANGAOIL
Entity Type:Individual
Prefix:
First Name:BERNADETH
Middle Name:MANGAOIL
Last Name:DANNUG
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 1:1430 SEAGIRT BLVD APT 6P
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4530
Mailing Address - Country:US
Mailing Address - Phone:516-401-9734
Mailing Address - Fax:
Practice Address - Street 1:1430 SEAGIRT BLVD APT 6P
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4530
Practice Address - Country:US
Practice Address - Phone:516-401-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY748477163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health