Provider Demographics
NPI:1790557478
Name:BERNARD, CHRISTINE RENEE (LLC)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 N LUKE ST APT 205B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-1955
Mailing Address - Country:US
Mailing Address - Phone:337-254-6141
Mailing Address - Fax:
Practice Address - Street 1:806C DELHOMME AVE
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5126
Practice Address - Country:US
Practice Address - Phone:337-254-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA177981376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide