Basic Information
Provider Information | |||||||||
NPI: | 1679996763 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CIARCIELLO | ||||||||
FirstName: | BERNADETTE | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 333 N SUMMIT STREET | ||||||||
Address2: | FLOOR 7 | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 43604 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192526018 | ||||||||
FaxNumber: | 8005645952 | ||||||||
Practice Location | |||||||||
Address1: | HEARTLAND CARE PARTNERS | ||||||||
Address2: | 1480 OXFORD VALLEY ROAD | ||||||||
City: | YARDLEY | ||||||||
State: | PA | ||||||||
PostalCode: | 190675630 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8004271902 | ||||||||
FaxNumber: | 4195312664 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2014 | ||||||||
LastUpdateDate: | 02/16/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP013556 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 1851397731 | 01 | PA | GROUP NPI | OTHER |