Provider Demographics
NPI:1477651396
Name:BERNARDINI, MARIANNE (APN)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:BERNARDINI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-8522
Mailing Address - Country:US
Mailing Address - Phone:856-776-3295
Mailing Address - Fax:
Practice Address - Street 1:994 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6937
Practice Address - Country:US
Practice Address - Phone:856-776-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00135000363L00000X
CT003083363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004030839Medicaid
CT5000001378Medicare ID - Type UnspecifiedFOR CLINIC C00814
CT004030839Medicaid