Provider Demographics
NPI:1689770745
Name:BERNHEIM, MARY JOSPEHINE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOSPEHINE
Last Name:BERNHEIM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:12 NORFOLK RD
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-0080
Mailing Address - Country:US
Mailing Address - Phone:860-567-0557
Mailing Address - Fax:
Practice Address - Street 1:12 NORFOLK RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-2537
Practice Address - Country:US
Practice Address - Phone:860-567-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9184500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered