Provider Demographics
NPI:1598036170
Name:GERNON, ARLENE BAZATA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:BAZATA
Last Name:GERNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 THIRD AVE FELICIO ADMINISTRATION BLDG
Mailing Address - Street 2:BRENTWOOD PUBLIC SCHOOLS
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-434-2408
Mailing Address - Fax:
Practice Address - Street 1:52 THIRD AVE FELICIO ADMINISTRATION BLDG
Practice Address - Street 2:BRENTWOOD PUBLIC SCHOOLS
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-434-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 241070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22 241070OtherNYS LICENSURE
NY22 241070OtherRN LICENSURE