Provider Demographics
NPI:1124270772
Name:BERNIER MATTE, BRENDA (LPN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BERNIER MATTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:BERNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-4537
Mailing Address - Country:US
Mailing Address - Phone:603-845-8352
Mailing Address - Fax:
Practice Address - Street 1:12 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4537
Practice Address - Country:US
Practice Address - Phone:603-845-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60806164W00000X
NH012602-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse