Provider Demographics
NPI:1023760964
Name:MUBANG, BERNADETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MUBANG
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 1:52 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-1137
Mailing Address - Country:US
Mailing Address - Phone:207-255-4006
Mailing Address - Fax:
Practice Address - Street 1:52 NORTH ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1137
Practice Address - Country:US
Practice Address - Phone:207-255-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No374U00000XNursing Service Related ProvidersHome Health Aide