=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811808892
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISA BERNARDING RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 WASHINGTON ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-4034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-785-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29153 WIMMER RD
-----------------------------------------------------
City | REDWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13679-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Registered Nurse
-----------------------------------------------------
License Number | 806412
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------