Doctor Name: | MRS. MICHELLE LENORA BERNARD |
NPI Number: | 1144284621 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 096479 |
Business Practice Address: | 126 Missouri Ave Box 1239 Fort Leonard Wood, MO - 654738952 |
Business Phone Number: | 5733292180 |
Business Fax Number: | 5733298305 |
Mailing Address: | 126 Missouri Ave, Box 1239 FORT LEONARD WOOD |
State: | MO |
Postal Code: | 654738952 |
Phone Number: | 5733292180 |
Fax Number: | 5733298305 |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 096479 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |