Provider Demographics
NPI:1538975412
Name:BERMUDEZ, GRISELDA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:TX
Mailing Address - Zip Code:79821-7129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11335 SSG SIMS ST
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918-8033
Practice Address - Country:US
Practice Address - Phone:915-742-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX699065163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management