Healthcare Provider Details

I. General information

NPI: 1265428072
Provider Name (Legal Business Name): JEAN M BERNHARDT RN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HANOVER ST
BOSTON MA
02113-1901
US

IV. Provider business mailing address

332 HANOVER ST
BOSTON MA
02113-1901
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number169252
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: