Doctor Name: | JESSICA LASAK BERNARDI |
NPI Number: | 1013311000 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209011971 |
Business Practice Address: | 25 N. Winfield Road Winfield, IL - 60190 |
Business Phone Number: | 6309332747 |
Business Fax Number: | 6309332827 |
Mailing Address: | 25 N. Winfield Road, WINFIELD |
State: | IL |
Postal Code: | 60190 |
Phone Number: | 6309332747 |
Fax Number: | 6309332827 |
NPI Enumeration Date: | 10/20/2014 |
NPI Last Update Date: | 12/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 209011971 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |