Provider Demographics
NPI:1174164412
Name:BERNARD, JOELLA MARIE (RN)
Entity type:Individual
Prefix:
First Name:JOELLA
Middle Name:MARIE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E SAN FERNANDO ST PH 17
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-7419
Mailing Address - Country:US
Mailing Address - Phone:408-292-6835
Mailing Address - Fax:
Practice Address - Street 1:438 N WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1439
Practice Address - Country:US
Practice Address - Phone:408-254-6848
Practice Address - Fax:408-254-6838
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492144163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health