Healthcare Provider Details

I. General information

NPI: 1720062219
Provider Name (Legal Business Name): BERNICE ANN ETTORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: BERNICE ANN CASTELLUCCI RN

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011 BLDG 704 ATTN MCJA QM USA MEDICAL DEPARTMENT ACTIVITY JAPAN
APO AP
96338-5011
JP

IV. Provider business mailing address

UNIT 45011 BLDG 704 ATTN MCJA QM USA MEDICAL DEPARTMENT ACTIVITY JAPAN
APO AP
96338-5011
JP

V. Phone/Fax

Practice location:
  • Phone: 011813117638206
  • Fax: 011813117638183
Mailing address:
  • Phone: 011813117638206
  • Fax: 011813117638183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number205258
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN098020
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: