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General NPI Number Information
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NPI Number | 1801103981
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Entity Type | Individual
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Provider Name | BERNADETTE BOJORGE BAEZ RN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 6821 W KNOX DR
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City | WASILLA
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State | AK
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Zip | 99654-9293
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Country | US
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Telephone | 907-373-0821
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Fax |
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Provider Business Mailing Address
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Address Line | 6821 W KNOX DR
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City | WASILLA
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State | AK
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Zip | 99654-9293
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Country | US
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Telephone | 907-373-0821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 28683
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 28683
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License Number State | AK
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