Provider Demographics
NPI:1568446805
Name:BERNARD, RENE L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:L
Last Name:BERNARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CUSUMANO PROFESSIONAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6736
Mailing Address - Country:US
Mailing Address - Phone:618-244-4800
Mailing Address - Fax:618-643-3164
Practice Address - Street 1:104 E MARKET ST
Practice Address - Street 2:
Practice Address - City:MC LEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859-1317
Practice Address - Country:US
Practice Address - Phone:618-643-3051
Practice Address - Fax:618-643-3164
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20900237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL788058OtherHEALTHLINK #
IL1174669568OtherCLINIC NPI
ILP00425296OtherRAILROAD MEDICARE #
ILDG2570OtherRAILROAD MEDICARE #
IL03332007OtherBCBS#
ILQ24440OtherUPIN #
IL788058OtherHEALTHLINK #
ILDG2570OtherRAILROAD MEDICARE #
ILK38114Medicare PIN