Provider Demographics
NPI:1306946280
Name:DRAGICH, BERNADETTE M (CFNP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:DRAGICH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2936
Mailing Address - Country:US
Mailing Address - Phone:304-487-2363
Mailing Address - Fax:
Practice Address - Street 1:216 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2135
Practice Address - Country:US
Practice Address - Phone:304-425-2355
Practice Address - Fax:304-487-0092
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7101211000Medicaid