Provider Demographics
NPI:1336974906
Name:GANDOLFI, BERNADETTE KATHERINE
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:KATHERINE
Last Name:GANDOLFI
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 1:24 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3428
Mailing Address - Country:US
Mailing Address - Phone:978-500-2349
Mailing Address - Fax:
Practice Address - Street 1:24 MONROE ST
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3428
Practice Address - Country:US
Practice Address - Phone:978-500-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH073631-21363LF0000X
MA2297494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily