Provider Demographics
NPI:1710302773
Name:FISH, BERNADETTE (LPN)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 E CAMELBACK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4500
Mailing Address - Country:US
Mailing Address - Phone:602-385-8733
Mailing Address - Fax:
Practice Address - Street 1:3131 E CAMELBACK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4500
Practice Address - Country:US
Practice Address - Phone:602-385-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP047374164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse