Provider Demographics
NPI:1922338268
Name:BERNACKI, KRISTEN G (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:G
Last Name:BERNACKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MCGREGOR ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3765
Mailing Address - Country:US
Mailing Address - Phone:603-695-2500
Mailing Address - Fax:
Practice Address - Street 1:87 MCGREGOR ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3765
Practice Address - Country:US
Practice Address - Phone:603-695-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-09
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH043574-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30347933Medicaid
NH30347933Medicaid