Provider Demographics
NPI:1568826238
Name:BERNAT, LANA (CNM)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:BERNAT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18564 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-681-6502
Mailing Address - Fax:
Practice Address - Street 1:18564 US ROUTE 11
Practice Address - Street 2:STE 4
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5900
Practice Address - Country:US
Practice Address - Phone:315-681-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695793163W00000X
NYF001731-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse