Provider Demographics
NPI:1740892868
Name:BERNARD, ADAM DANE (FNP-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DANE
Last Name:BERNARD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 FAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-4722
Mailing Address - Country:US
Mailing Address - Phone:641-799-0894
Mailing Address - Fax:
Practice Address - Street 1:2162 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5368
Practice Address - Country:US
Practice Address - Phone:563-391-1024
Practice Address - Fax:563-386-0965
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA156111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner