Provider Demographics
NPI:1710970678
Name:BERNHARD, ADRIENNE (CRNA, MS)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:BERNHARD
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 LEEDS ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5060
Mailing Address - Country:US
Mailing Address - Phone:985-641-7367
Mailing Address - Fax:
Practice Address - Street 1:985 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2063
Practice Address - Country:US
Practice Address - Phone:985-690-8200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN028489 AP01018367500000X
MSR735711367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900001Medicaid
LA59915Medicare ID - Type Unspecified
LA1900001Medicaid