Provider Demographics
NPI:1457718959
Name:LAFOREST, BERNADETTE ROSARIA
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ROSARIA
Last Name:LAFOREST
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 1:44 KENT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-1256
Mailing Address - Country:US
Mailing Address - Phone:520-304-1777
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL STE 100
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5901
Practice Address - Country:US
Practice Address - Phone:518-561-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY503294163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse