Provider Demographics
NPI:1134360811
Name:BERNARD, PATRICIA MANYIKA (LICENSED NURSE)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MANYIKA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:MANYIKA
Other - Last Name:DUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25319 RUNSEY CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2411
Mailing Address - Country:US
Mailing Address - Phone:951-208-2742
Mailing Address - Fax:
Practice Address - Street 1:25319 RUNSEY CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-2411
Practice Address - Country:US
Practice Address - Phone:951-208-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN220093164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse