MEDICARE: BERNA JEAN BESANA MIRAFUENTE AGNP

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	163WM0705X	Medical-Surgical Registered Nurse	205278	NC
2	363L00000X	Nurse Practitioner	5018692	NC
3	363LG0600X	Gerontology Nurse Practitioner	5018692	NC

General Provider Information

NPI Number	:	1477255057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNA JEAN BESANA MIRAFUENTE AGNP

Provider Business Mailing Address
First Line	:	209 ALEXANDER PRESTON LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7295
Country	:	US
Telephone Number	:	336-409-7683
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 ALEXANDER PRESTON LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7295
Country	:	US
Telephone Number	:	336-409-7683
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	02/11/2026

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