Provider Demographics
NPI:1063898179
Name:BERNOTAITIS, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BERNOTAITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 ROXANNA NEW BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-9644
Mailing Address - Country:US
Mailing Address - Phone:937-825-7470
Mailing Address - Fax:
Practice Address - Street 1:1566 ROXANNA NEW BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9644
Practice Address - Country:US
Practice Address - Phone:937-825-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care