Provider Demographics
NPI:1417331638
Name:BERNIER, DIANA (PNP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:BERNIER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 NORTHERN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5335
Mailing Address - Country:US
Mailing Address - Phone:516-622-5070
Mailing Address - Fax:516-622-5060
Practice Address - Street 1:865 NORTHERN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5335
Practice Address - Country:US
Practice Address - Phone:516-622-5070
Practice Address - Fax:516-622-5060
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382550363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics