Provider Demographics
NPI:1760721161
Name:MIU, BERNADINE R (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BERNADINE
Middle Name:R
Last Name:MIU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BERNA
Other - Middle Name:
Other - Last Name:CHAVEZ-CABRAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:483 W SEED FARM RD
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-2254
Mailing Address - Country:US
Mailing Address - Phone:520-796-2714
Mailing Address - Fax:
Practice Address - Street 1:483 W SEED FARM RD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-5000
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-528-1255
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP4823OtherLICENSE FNP