Provider Demographics
NPI:1063769321
Name:CORREA, BERNADETTE ALLEN (RN)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:ALLEN
Last Name:CORREA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7515
Mailing Address - Country:US
Mailing Address - Phone:910-343-8209
Mailing Address - Fax:910-343-8836
Practice Address - Street 1:2222 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7515
Practice Address - Country:US
Practice Address - Phone:910-343-8209
Practice Address - Fax:910-343-8836
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101823163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse