Healthcare Provider Details

I. General information

NPI: 1053577940
Provider Name (Legal Business Name): BERNARD ANTONY FERNANDES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE HC-71
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

1415 TULANE AVE HC-71
NEW ORLEANS LA
70112-2600
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-3290
  • Fax: 504-988-6216
Mailing address:
  • Phone: 504-988-3290
  • Fax: 504-988-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAP05548
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP05548
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: