Basic Information
| Provider Information | |||||||||
| NPI: | 1518079201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | BERNADINE | ||||||||
| MiddleName: | FRANCES | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN,C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21813 WATSON RD | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201756508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033274570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21641 RIDGETOP CIR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201666597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712583026 | ||||||||
| FaxNumber: | 5712583032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 0001078571 | VA | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.