Healthcare Provider Details

I. General information

NPI: 1912109109
Provider Name (Legal Business Name): RENEE BERNARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE BERNARD NP

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7585
  • Fax: 401-444-2019
Mailing address:
  • Phone: 401-444-7585
  • Fax: 401-444-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNPP37312
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRNP33588
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN00300
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN00300
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: