Provider Demographics
NPI:1609588573
Name:BERNARDINO, ELMER (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:
Last Name:BERNARDINO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 N CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2311
Mailing Address - Country:US
Mailing Address - Phone:773-592-0203
Mailing Address - Fax:
Practice Address - Street 1:6420 N CALIFORNIA AVE UPPR 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5276
Practice Address - Country:US
Practice Address - Phone:773-465-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily