Provider Demographics
NPI:1497017842
Name:ST. BERNARD, KERIN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KERIN
Middle Name:
Last Name:ST. BERNARD
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 1:468 BEACH 63RD ST
Mailing Address - Street 2:PH
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1421
Mailing Address - Country:US
Mailing Address - Phone:646-321-7308
Mailing Address - Fax:
Practice Address - Street 1:468 BEACH 63RD ST
Practice Address - Street 2:PH
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1421
Practice Address - Country:US
Practice Address - Phone:646-321-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300110-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse