Provider Demographics
NPI:1740253426
Name:BERNSTEIN, KENNETH LAURENCE (CRNA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LAURENCE
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SWIFT CREEK XING
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7268
Mailing Address - Country:US
Mailing Address - Phone:954-495-5474
Mailing Address - Fax:
Practice Address - Street 1:106 SWIFT CREEK XING
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7268
Practice Address - Country:US
Practice Address - Phone:954-495-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3173792367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306208200Medicaid
FLG3479YMedicare ID - Type Unspecified
FLG3479ZMedicare ID - Type Unspecified