Provider Demographics
NPI:1912477258
Name:BERNAL, JOEL MADRID (RN)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:MADRID
Last Name:BERNAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 N PECOS ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-2640
Mailing Address - Country:US
Mailing Address - Phone:432-290-6535
Mailing Address - Fax:
Practice Address - Street 1:1306 N PECOS ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2640
Practice Address - Country:US
Practice Address - Phone:432-290-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX858744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse