Provider Demographics
NPI:1518312693
Name:NICHOLSON-BERNARD, SANDRINE
Entity Type:Individual
Prefix:
First Name:SANDRINE
Middle Name:
Last Name:NICHOLSON-BERNARD
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 1:67 MYRTLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3230
Mailing Address - Country:US
Mailing Address - Phone:862-215-1471
Mailing Address - Fax:
Practice Address - Street 1:67 MYRTLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3230
Practice Address - Country:US
Practice Address - Phone:862-215-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA200013181376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide