Provider Demographics
NPI:1912109109
Name:BERNARD, RENEE (NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-7585
Mailing Address - Fax:401-444-2019
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-7585
Practice Address - Fax:401-444-2019
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37312363LA2100X
RIRNP33588363LC0200X
RIAPRN00300363LC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIQ59952Medicare UPIN