Provider Demographics
NPI:1912614538
Name:BERNARD, FAITH (FNP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 W LINCOLN HWY STE 1A
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1098
Mailing Address - Country:US
Mailing Address - Phone:773-934-1761
Mailing Address - Fax:
Practice Address - Street 1:5521 W LINCOLN HWY STE 1A
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1098
Practice Address - Country:US
Practice Address - Phone:219-769-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013214B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5370-02-5142OtherDRIVER'S LICENSE NUMBER
IN28163799AOtherREGISTERED NURSE LICENSE NUMBER