Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 23610 | KY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 23610 | KY |
NPI | 1710926738 |
---|---|
Provider Name | Nannette E Bernales |
First Address | Lexington, KY 40504-3229 |
Second Address | Florence, KY 41042-1381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080105457 | RAILROAD MEDICARE (01) | KY |
2332407 | (05) | OH |
64236102 | (05) | KY |
C76264 | (02) | KY |