Healthcare Provider Details

I. General information

NPI: 1538903554
Provider Name (Legal Business Name): REY ANTHONY BERNARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 DOTY RD STE A
WOODSTOCK IL
60098-7530
US

IV. Provider business mailing address

3707 DOTY RD STE A
WOODSTOCK IL
60098-7530
US

V. Phone/Fax

Practice location:
  • Phone: 815-334-5018
  • Fax: 815-206-2822
Mailing address:
  • Phone: 815-334-5018
  • Fax: 815-206-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: