Healthcare Provider Details

I. General information

NPI: 1679483796
Provider Name (Legal Business Name): MADELINE KATE BERNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SHIPYARD BLVD STE 460
WILMINGTON NC
28403-8023
US

IV. Provider business mailing address

2424 SALINGER CT APT 103
WILMINGTON NC
28412-7544
US

V. Phone/Fax

Practice location:
  • Phone: 743-220-8630
  • Fax:
Mailing address:
  • Phone: 757-292-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: