Provider Demographics
NPI:1417159260
Name:BERNATOWICZ, NICOLE LYNAE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNAE
Last Name:BERNATOWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WILLIAM WAY NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4369
Mailing Address - Country:US
Mailing Address - Phone:423-478-1050
Mailing Address - Fax:888-853-7312
Practice Address - Street 1:1060 WILLIAM WAY NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4369
Practice Address - Country:US
Practice Address - Phone:423-478-1050
Practice Address - Fax:888-853-7312
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002753207Q00000X
IN02003416A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine