Healthcare Provider Details

I. General information

NPI: 1992773105
Provider Name (Legal Business Name): JILL S BERNHARDT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL S NOBLE NP

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 LEHIGH STATION RD
HENRIETTA NY
14467-9616
US

IV. Provider business mailing address

39 NORBROOK RD
FAIRPORT NY
14450-8959
US

V. Phone/Fax

Practice location:
  • Phone: 585-359-5028
  • Fax:
Mailing address:
  • Phone: 585-425-3506
  • Fax: 585-359-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF332981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: