Healthcare Provider Details

I. General information

NPI: 1063955193
Provider Name (Legal Business Name): MRS. MICHELE D BERNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 CENTENNIAL AVE
NORTH BALDWIN NY
11510-1916
US

IV. Provider business mailing address

191 LALUE
PORT AU PRINCE DELMAS
WI
HT

V. Phone/Fax

Practice location:
  • Phone: 516-717-8240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number580468-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: