Provider Demographics
NPI:1720062219
Name:ETTORE, BERNICE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:ANN
Last Name:ETTORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BERNICE
Other - Middle Name:ANN
Other - Last Name:CASTELLUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:UNIT 45011 BLDG 704 ATTN MCJA QM
Mailing Address - Street 2:USA MEDICAL DEPARTMENT ACTIVITY JAPAN
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-5011
Mailing Address - Country:JP
Mailing Address - Phone:01181311-763-8206
Mailing Address - Fax:01181311-763-8183
Practice Address - Street 1:UNIT 45011 BLDG 704 ATTN MCJA QM
Practice Address - Street 2:USA MEDICAL DEPARTMENT ACTIVITY JAPAN
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338-5011
Practice Address - Country:JP
Practice Address - Phone:01181311-763-8206
Practice Address - Fax:01181311-763-8183
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205258163WX0106X
AZRN098020163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0106XNursing Service ProvidersRegistered NurseOccupational Health