Provider Demographics
NPI:1558500637
Name:HIRST, BERNADETTE D (APRN)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:D
Last Name:HIRST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 SUNSET FARM RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1332
Mailing Address - Country:US
Mailing Address - Phone:860-561-5310
Mailing Address - Fax:
Practice Address - Street 1:4 BATCHELDER RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3028
Practice Address - Country:US
Practice Address - Phone:860-687-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002197363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics