Healthcare Provider Details

I. General information

NPI: 1093589525
Provider Name (Legal Business Name): MONICA LYN BERNHOFFER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7200
  • Fax:
Mailing address:
  • Phone: 419-696-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.0035395
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0035395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: