Provider Demographics
NPI:1275589608
Name:BERNARD, GABRIELLE DIONYSE LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DIONYSE LAUREN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:DIONY LAUREN
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:1205 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5577
Practice Address - Country:US
Practice Address - Phone:425-690-3475
Practice Address - Fax:425-690-9475
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85928207P00000X
WAMD60862290207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G859280OtherBLUE SHIELD
CA050126CG35107OtherVALLEY PRES TRAILBLAZER
CAG85928OtherBLUE CROSS
CA930123114OtherVALLEY PRES RAILROAD
WA2106688Medicaid
CA00G859280Medicaid
CA00G859280OtherCALOPTIMA
CAG35107Medicare UPIN
CAG85928OtherBLUE CROSS
CAWG85928BMedicare Oscar/Certification
CAWG85928CMedicare PIN