Provider Demographics
NPI:1245289321
Name:WILLIAMSON, BERNADETTE ELL (CRNP)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:ELL
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6931 GANEYS WHARF RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MD
Mailing Address - Zip Code:21655-1814
Mailing Address - Country:US
Mailing Address - Phone:410-673-7819
Mailing Address - Fax:
Practice Address - Street 1:508 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3834
Practice Address - Country:US
Practice Address - Phone:410-822-9133
Practice Address - Fax:410-822-9513
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP30276Medicare UPIN
MD054LA646Medicare PIN