Provider Demographics
NPI:1235184938
Name:BERNARD, LINDA MAE (APN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 WEST LAKE
Mailing Address - Street 2:L-120
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1806
Mailing Address - Country:US
Mailing Address - Phone:708-488-1919
Mailing Address - Fax:708-488-2370
Practice Address - Street 1:7411 WEST LAKE
Practice Address - Street 2:L-120
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1806
Practice Address - Country:US
Practice Address - Phone:708-488-1919
Practice Address - Fax:708-488-2370
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000954363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89945Medicare UPIN
209728Medicare PIN