Provider Demographics
NPI:1760854533
Name:BERNARD, MARIE GRETTA
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:GRETTA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CREEK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2768
Mailing Address - Country:US
Mailing Address - Phone:609-845-3988
Mailing Address - Fax:609-288-6078
Practice Address - Street 1:404 CREEK CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2768
Practice Address - Country:US
Practice Address - Phone:609-845-3988
Practice Address - Fax:609-288-6078
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00558800164W00000X, 363LP0808X
NJ26N012308800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner