Provider Demographics
NPI:1861491672
Name:BERNIER, NICHOLAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:P
Last Name:BERNIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2024 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-828-7100
Mailing Address - Fax:218-828-3103
Practice Address - Street 1:2024 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3054
Practice Address - Country:US
Practice Address - Phone:218-828-7100
Practice Address - Fax:218-828-3103
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND48406Medicare UPIN