Provider Demographics
NPI:1912223256
Name:BERNARD, ANGELIA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:MARIE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:MARIE
Other - Last Name:DEBIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:23 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1017
Mailing Address - Country:US
Mailing Address - Phone:315-769-8441
Mailing Address - Fax:315-769-3902
Practice Address - Street 1:23 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1017
Practice Address - Country:US
Practice Address - Phone:315-769-8441
Practice Address - Fax:315-769-3902
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22454059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22454059OtherRN LICENSE