Healthcare Provider Details

I. General information

NPI: 1851208839
Provider Name (Legal Business Name): NICOLE BERNATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PALMER DR
DEFIANCE OH
43512-3499
US

IV. Provider business mailing address

PO BOX 782
WEST UNITY OH
43570-0782
US

V. Phone/Fax

Practice location:
  • Phone: 419-784-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.533839
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: