Provider Demographics
NPI:1306120316
Name:BAZILE, BERTHA
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:BAZILE
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 1:454 W 146TH ST
Mailing Address - Street 2:APT. 5R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4723
Mailing Address - Country:US
Mailing Address - Phone:327-549-6686
Mailing Address - Fax:
Practice Address - Street 1:454 W 146TH ST
Practice Address - Street 2:APT. 5R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4723
Practice Address - Country:US
Practice Address - Phone:327-549-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse