Provider Demographics
NPI:1689831273
Name:HUNTER, BERNADETTE SHARON (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:SHARON
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LPN
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Mailing Address - Street 1:B STREET BLDG 29709
Mailing Address - Street 2:CONNELLY HEALTH CLINIC ATTN DDEAMC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-5174
Mailing Address - Fax:706-787-5145
Practice Address - Street 1:B STREET BLDG 29709
Practice Address - Street 2:CONNELLY HEALTH CLINIC ATTN DDEAMC
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-5174
Practice Address - Fax:706-787-5145
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPN044950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse