MEDICARE: BERNADETTE ANN HARLOW PMHNP-BC, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024165791	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024165791	VA

General Provider Information

NPI Number	:	1043427404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE ANN HARLOW PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	4440 TWAIN AVE APT 164
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-3470
Country	:	US
Telephone Number	:	571-225-2843
Fax Number	:	619-556-8627

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-4826
Country	:	US
Telephone Number	:	619-556-8090
Fax Number	:	619-556-8627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	03/12/2021

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