MEDICARE: THERESA C BERNIARD CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	53868	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	430075913	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	82761U	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1154460103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA C BERNIARD CRNA

Provider Business Mailing Address
First Line	:	3023 FAIRHOPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3226
Country	:	US
Telephone Number	:	713-376-1386
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 FAIRHOPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3226
Country	:	US
Telephone Number	:	713-376-1386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/12/2013

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Directions to “ THERESA C BERNIARD CRNA” Practice Location

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