1568446805 NPI number — MRS. RENE L BERNARD FNP

Table of content: MRS. RENE L BERNARD FNP (NPI 1568446805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568446805 NPI number — MRS. RENE L BERNARD FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNARD
Provider First Name:
RENE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568446805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CUSUMANO PROFESSIONAL PLAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62864-6736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-244-4800
Provider Business Mailing Address Fax Number:
618-643-3164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC LEANSBORO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62859-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-643-3051
Provider Business Practice Location Address Fax Number:
618-643-3164
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  20900237 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 788058 . This is a "HEALTHLINK #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1174669568 . This is a "CLINIC NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00425296 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DG2570 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 03332007 . This is a "BCBS#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: Q24440 . This is a "UPIN #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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