Provider Demographics
NPI:1508605825
Name:BERNARDEZ, ROBERT (RN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BERNARDEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26039 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-3966
Mailing Address - Country:US
Mailing Address - Phone:586-202-5303
Mailing Address - Fax:
Practice Address - Street 1:27196 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3537
Practice Address - Country:US
Practice Address - Phone:248-439-0455
Practice Address - Fax:248-439-0456
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265443163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice