Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209011971 | IL |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 209011971 | IL |
NPI | 1013311000 |
---|---|
Provider Name | Jessica Lasak Bernardi |
First Address | Winfield, IL 60190-1222 |
Second Address | Winfield, IL 60190-1222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2014 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206147 | MEDICARE PTAN (GROUP) (01) | IL |
F400172928 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |