Provider Demographics
NPI:1184320921
Name:BERNARDO, JUNIECA MABABA (BSN, RN, CEFM)
Entity type:Individual
Prefix:
First Name:JUNIECA
Middle Name:MABABA
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:BSN, RN, CEFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 BROOK BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6369
Mailing Address - Country:US
Mailing Address - Phone:984-242-6522
Mailing Address - Fax:
Practice Address - Street 1:1305 BROOK BLUFF RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6369
Practice Address - Country:US
Practice Address - Phone:984-242-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse