Provider Demographics
NPI:1700039062
Name:BERNADINE WILSON SITTING SERVICE
Entity Type:Organization
Organization Name:BERNADINE WILSON SITTING SERVICE
Other - Org Name:BERNADINE WILSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-237-2071
Mailing Address - Street 1:61492 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4564
Mailing Address - Country:US
Mailing Address - Phone:985-237-2071
Mailing Address - Fax:985-863-1776
Practice Address - Street 1:61492 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-4564
Practice Address - Country:US
Practice Address - Phone:985-237-2071
Practice Address - Fax:985-863-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA94095423305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization