Provider Demographics
NPI:1437346970
Name:BERNARD, JONATHAN RUSSELL (RN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RUSSELL
Last Name:BERNARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 EVANS DR
Mailing Address - Street 2:EASTMAN HEIGHTS
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-2403
Mailing Address - Country:US
Mailing Address - Phone:302-242-8730
Mailing Address - Fax:
Practice Address - Street 1:631 EVANS DR
Practice Address - Street 2:EASTMAN HEIGHTS
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-2403
Practice Address - Country:US
Practice Address - Phone:302-242-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0033582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse