Healthcare Provider Details

I. General information

NPI: 1689823007
Provider Name (Legal Business Name): SUSAN M BERNS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUE P BERNS NNP

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E CLIFTY DR
MADISON IN
47250-4621
US

IV. Provider business mailing address

311 E CLIFTY DR
MADISON IN
47250-4621
US

V. Phone/Fax

Practice location:
  • Phone: 859-685-5325
  • Fax:
Mailing address:
  • Phone: 859-685-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71002808A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number71002808A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: