Provider Demographics
NPI:1689150153
Name:NZATSE, BERNADETTE BEATA
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:BEATA
Last Name:NZATSE
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 1:13020 RAINTREE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5272
Mailing Address - Country:US
Mailing Address - Phone:240-645-3320
Mailing Address - Fax:
Practice Address - Street 1:13020 RAINTREE TER
Practice Address - Street 2:13020 RAINTREE TERRACE
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5272
Practice Address - Country:US
Practice Address - Phone:240-645-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12697374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN-232-085-080-704OtherDRIVER LICENSE
DCHHA12697OtherLICENCE NUMBER