Provider Demographics
NPI:1275327488
Name:KAVANAGH, BERNADETTE MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MISS
First Name:BERNADETTE
Middle Name:MARIE
Last Name:KAVANAGH
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 S MAYFAIR AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3654
Mailing Address - Country:US
Mailing Address - Phone:650-921-5612
Mailing Address - Fax:
Practice Address - Street 1:1286 S MAYFAIR AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3654
Practice Address - Country:US
Practice Address - Phone:650-921-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672960163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health