Provider Demographics
NPI:1639569957
Name:TAN, BERNARDETTE (RN)
Entity Type:Individual
Prefix:
First Name:BERNARDETTE
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BERNARDETTE
Other - Middle Name:TAN
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2605 MARIA LUIZA DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4684
Mailing Address - Country:US
Mailing Address - Phone:956-867-8447
Mailing Address - Fax:
Practice Address - Street 1:2601 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8942
Practice Address - Country:US
Practice Address - Phone:956-291-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683833163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse