Provider Demographics
NPI:1578880423
Name:BERMUDEZ, ANNA KARINA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KARINA
Last Name:BERMUDEZ
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 1:110 BOLTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8738
Mailing Address - Country:US
Mailing Address - Phone:859-353-7152
Mailing Address - Fax:
Practice Address - Street 1:110 BOLTON AVE APT 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8738
Practice Address - Country:US
Practice Address - Phone:859-353-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator