Provider Demographics
NPI:1518396605
Name:PHILEMONT BERNARD, GINOUX
Entity Type:Individual
Prefix:
First Name:GINOUX
Middle Name:
Last Name:PHILEMONT 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 1:51 HALL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3414
Mailing Address - Country:US
Mailing Address - Phone:617-230-6212
Mailing Address - Fax:
Practice Address - Street 1:51 HALL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3414
Practice Address - Country:US
Practice Address - Phone:617-230-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse