Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 02006071A | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 02006071A | IN |
NPI | 1245658004 |
---|---|
Provider Name | Bernadette Lourdes O'neil |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2014 |
Last Update Date | 31/03/2021 |