Healthcare Provider Details

I. General information

NPI: 1578793329
Provider Name (Legal Business Name): JEFFREY BERNER R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

3095 NW GRAVENSTEIN ST
CAMAS WA
98607-7377
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2064
  • Fax:
Mailing address:
  • Phone: 360-834-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number200542648RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: