Provider Demographics
NPI:1801368147
Name:BERNARD, DAVID QUINTANA
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:QUINTANA
Last Name:BERNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BURLESON RD
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-4826
Mailing Address - Country:US
Mailing Address - Phone:432-528-6158
Mailing Address - Fax:
Practice Address - Street 1:210 BURLESON RD
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:TX
Practice Address - Zip Code:79731-4826
Practice Address - Country:US
Practice Address - Phone:432-528-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX706509163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse