Provider Demographics
NPI:1952971483
Name:BERNDT, JONATHAN PETER (CRNA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PETER
Last Name:BERNDT
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 1:2705 C ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3120
Mailing Address - Country:US
Mailing Address - Phone:559-859-8940
Mailing Address - Fax:
Practice Address - Street 1:2705 C ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3120
Practice Address - Country:US
Practice Address - Phone:559-859-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001719367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered