Individual
BERTHA BAZILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
454 W 146TH ST, APT. 5R, NEW YORK, NY 10031-4723
(327) 549-6686
Mailing address
454 W 146TH ST, APT. 5R, NEW YORK, NY 10031-4723
(327) 549-6686
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303721
NY
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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