Provider Demographics
NPI:1376591230
Name:BERNARDO, STUART (APN)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:BERNARDO
Suffix:
Gender:M
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:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-946-5399
Practice Address - Fax:702-946-5424
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376591230Medicaid
NVFB713Y (CQ328A)Medicare PIN
NVFB713ZMedicare PIN
NVFB713X (CQ328B)Medicare PIN
NV100835Medicare ID - Type Unspecified