Provider Demographics
NPI:1689823007
Name:BERNS, SUSAN P (NNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:P
Last Name:BERNS
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:P
Other - Last Name:BERNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NNP
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 E SR 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0300
Practice Address - Fax:812-801-0585
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002808A363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care