MEDICARE: MRS. LEE A BERNARD N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	71000758A	IN

General Provider Information

NPI Number	:	1417959081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEE A BERNARD N.P.

Provider Business Mailing Address
First Line	:	1140 W MICHIGAN ST
Second Line	:	CF 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-274-5885
Fax Number	:	317-274-7657

Provider Business Practice Location Address
First Line	:	1140 W MICHIGAN ST
Second Line	:	CF 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-274-5885
Fax Number	:	317-274-7657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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