=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568754307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE BERNARD PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 05/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 WASHINGTON RD SUITE 7
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15301-2765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-225-3627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 918 BERKSHIRE AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15226-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-519-2728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | MA054615
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------