Provider Demographics
NPI:1356764641
Name:BERSABAL, ELLEN SARMIENTO (RN)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SARMIENTO
Last Name:BERSABAL
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 1:3975 56TH ST
Mailing Address - Street 2:APT. 1E
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3391
Mailing Address - Country:US
Mailing Address - Phone:347-761-4634
Mailing Address - Fax:
Practice Address - Street 1:3975 56TH ST
Practice Address - Street 2:APT. 1E
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3391
Practice Address - Country:US
Practice Address - Phone:347-761-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628491163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse