Provider Demographics
NPI:1205086477
Name:IRVING, BERTIELEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:BERTIELEE
Middle Name:
Last Name:IRVING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 FIFTH AVENUE
Mailing Address - Street 2:FIRST FLOOR BARKSDALE HEALTH CARE SERVICES INC
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803
Mailing Address - Country:US
Mailing Address - Phone:914-738-5600
Mailing Address - Fax:914-738-0658
Practice Address - Street 1:327 FIFTH AVENUE
Practice Address - Street 2:FIRST FLOOR BARKSDALE HEALTH CARE SERVICES INC
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803
Practice Address - Country:US
Practice Address - Phone:914-738-5600
Practice Address - Fax:914-738-0658
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00163975-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse