Provider Demographics
NPI:1457942575
Name:IHEDIOHANMA, BERNADINE
Entity type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:IHEDIOHANMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERNADINE
Other - Middle Name:
Other - Last Name:IHEDIOHANMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, NP-C, CRNP
Mailing Address - Street 1:2 UNIVERSITY PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6211
Mailing Address - Country:US
Mailing Address - Phone:551-295-8223
Mailing Address - Fax:
Practice Address - Street 1:39 V ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1329
Practice Address - Country:US
Practice Address - Phone:551-295-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily