Provider Demographics
NPI:1720015241
Name:DUBE, BERNADETTE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARIE
Last Name:DUBE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:9600 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7408
Mailing Address - Country:US
Mailing Address - Phone:405-230-9000
Mailing Address - Fax:405-230-9157
Practice Address - Street 1:4901 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6346
Practice Address - Country:US
Practice Address - Phone:405-230-9250
Practice Address - Fax:405-943-0742
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R10980Medicare UPIN